A cost-utility analysis comparing endovascular coiling to neurosurgical clipping in the treatment of aneurysmal subarachnoid haemorrhage

Ayla Ahmed; Yonis Ahmed; Kwaku Duah-Asante; Abayomi Lawal; Zain Mohiaddin; Hasan Nawab; Alexis Tang; Brian Wang; George Miller; Johann Malawana

doi:10.1007/s10143-022-01854-9

A cost-utility analysis comparing endovascular coiling to neurosurgical clipping in the treatment of aneurysmal subarachnoid haemorrhage

Neurosurg Rev. 2022 Oct;45(5):3259-3269. doi: 10.1007/s10143-022-01854-9. Epub 2022 Sep 3.

Authors

Ayla Ahmed¹, Yonis Ahmed¹, Kwaku Duah-Asante¹, Abayomi Lawal¹, Zain Mohiaddin¹, Hasan Nawab¹, Alexis Tang¹, Brian Wang^{2

3}, George Miller⁴, Johann Malawana⁴

Affiliations

¹ Faculty of Medicine, Department of Medicine, Imperial College London, London, UK.
² Department of Metabolism, Digestion and Reproduction, Imperial College Healthcare Trust, London, UK. Brian.wang1@nhs.net.
³ Centre for Digital Health and Education Research, School of Medicine, University of Central Lancashire, Preston, UK. Brian.wang1@nhs.net.
⁴ Centre for Digital Health and Education Research, School of Medicine, University of Central Lancashire, Preston, UK.

Abstract

Endovascular coiling (EC) has been identified in systematic reviews and meta-analyses to produce more favourable clinical outcomes in comparison to neurosurgical clipping (NC) when surgically treating a subarachnoid haemorrhage from a ruptured aneurysm. Cost-effectiveness analyses between both interventions have been done, but no cost-utility analysis has yet been published. This systematic review aims to perform an economic analysis of the relative utility outcomes and costs from both treatments in the UK. A cost-utility analysis was performed from the perspective of the National Health Service (NHS), over a 1-year analytic horizon. Outcomes were obtained from the randomised International Subarachnoid Aneurysm Trial (ISAT) and measured in terms of the patient's modified Rankin scale (mRS) grade, a 6-point disability scale that aims to quantify a patient's functional outcome following a stroke. The mRS score was weighted against the Euro-QoL 5-dimension (EQ-5D), with each state assigned a weighted utility value which was then converted into quality-adjusted life years (QALYs). A sensitivity analysis using different utility dimensions was performed to identify any variation in incremental cost-effectiveness ratio (ICER) if different input variables were used. Costs were measured in pounds sterling (£) and discounted by 3.5% to 2020/2021 prices. The cost-utility analysis showed an ICER of - £144,004 incurred for every QALY gained when EC was utilised over NC. At NICE's upper willingness-to-pay (WTP) threshold of £30,000, EC offered a monetary net benefit (MNB) of £7934.63 and health net benefit (HNB) of 0.264 higher than NC. At NICE's lower WTP threshold of £20,000, EC offered an MNB of £7478.63 and HNB of 0.374 higher than NC. EC was found to be more 'cost-effective' than NC, with an ICER in the bottom right quadrant of the cost-effectiveness plane-indicating that it offers greater benefits at lower costs. This is supported by the ICER being below the NICE's threshold of £20,000-£30,000 per QALY, and both MNB and HNB having positive values (> 0).

Keywords: Aneurysmal subarachnoid haemorrhage; Cost-utility analysis; Economic evaluation; Endovascular coiling; Neurosurgical clipping.

Publication types

Systematic Review

MeSH terms

Cost-Benefit Analysis
Humans
Quality of Life
State Medicine
Subarachnoid Hemorrhage* / surgery