Wolstenholme Jane, Rivero-Arias Oliver, Gray Alastair, Molyneux Andrew J, Kerr Richard S C, Yarnold Julia A, Sneade Mary
Health Economics Research Centre, Department of Public Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK.
Stroke. 2008 Jan;39(1):111-9. doi: 10.1161/STROKEAHA.107.482570. Epub 2007 Nov 29.
The International Subarachnoid Aneurysm Trial (ISAT) reported that endovascular coiling yields better clinical outcomes than surgical clipping at 1 year. The high cost of the consumables associated with the endovascular coiling procedure (particularly the coils) led health care purchasers to conclude that coiling was a more costly procedure overall. To examine this assumption and provide evidence for future policy, accurate and comprehensive data are required on the overall resource usage and cost of each strategy.
We provide detailed results of patient treatment pathways, resource utilization, and costs up to 24 months postrandomization for endovascular and neurosurgical treatment of aSAH. We report data on costs related to initial and subsequent procedures (ward days, ITU, equipment, staff, consumables, etc), adverse events, complications, and follow up. The data are based on a subsample of all patients randomized in ISAT, containing all patients across 22 UK centers (n=1644).
There was a nonsignificant difference - pound 1740 (- pound 3582 to pound 32) in the total 12-month cost of treatment in favor of endovascular treatment. Endovascular patients had higher costs than neurosurgical patients for the initial procedure, for the number and length of stay of subsequent procedures, and for follow-up angiograms. These were more than offset by lower costs related to length of stay for the initial procedure. In the following 12- to 24-month period, costs for subsequent procedures, angiograms, complications, and adverse events were greater for the endovascular patients, reducing the difference in total per patient cost to - pound 1228 (- pound 3199 to pound 786) over the first 24 months of follow-up.
No significant difference in costs between the endovascular and neurosurgery groups existed at 12- or 24-month follow up.
国际蛛网膜下腔动脉瘤试验（ISAT）报告称，血管内栓塞术在1年时的临床效果优于外科夹闭术。血管内栓塞术相关耗材（尤其是线圈）的高成本导致医疗保健采购方得出结论，总体而言栓塞术是一种成本更高的手术。为了检验这一假设并为未来政策提供证据，需要关于每种策略的总体资源使用和成本的准确而全面的数据。
我们提供了随机分组后长达24个月的aSAH血管内治疗和神经外科治疗的患者治疗路径、资源利用及成本的详细结果。我们报告了与初始及后续手术（病房天数、重症监护病房、设备、人员、耗材等）、不良事件、并发症及随访相关的成本数据。这些数据基于ISAT中所有随机分组患者的一个子样本，包含英国22个中心的所有患者（n = 1644）。
治疗12个月的总成本中，血管内治疗比外科治疗高1740英镑（-3582英镑至32英镑），差异无统计学意义。血管内治疗患者在初始手术、后续手术的次数和住院时间以及随访血管造影方面的成本高于神经外科治疗患者。这些成本增加被初始手术住院时间较短带来的较低成本所抵消。在接下来的12至24个月期间，血管内治疗患者在后续手术、血管造影、并发症及不良事件方面的成本更高，使随访的前24个月中每位患者的总成本差异降至-1228英镑（-3199英镑至786英镑）。
在12个月或24个月随访时，血管内治疗组和神经外科治疗组的成本无显著差异。
