Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
Department of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minnesota.
Neurosurgery. 2019 Dec 1;85(6):E1010-E1019. doi: 10.1093/neuros/nyz130.
Both stent-assisted coiling (SAC) and flow diversion with the Pipeline Embolization device (PED; Medtronic Inc) have been shown to be safe and clinically effective for treatment of small (<10 mm) unruptured aneurysms. However, the economic impact of these different techniques has not been established.
To analyze the cost-effectiveness between stent-assisted coiling and flow diversion using PED, including procedural costs, long-term outcomes, and aneurysm recurrence.
A decision-analytical study was performed with Markov modeling methods to simulate patients undergoing SAC or PED for treatment for unruptured aneurysms of sizes 5 and 7 mm. Input probabilities were derived from prior literature, and 1-way, 2-way, and probabilistic sensitivity analyses (PSA) were performed.
In base case calculation and PSA, PED was the dominant strategy for both the size groups, with and without consideration of indirect costs. One-way sensitivity analyses show that the conclusion remained robust when varying the retreatment rate of SAC from 0% to 50%, and only changes when the retreatment rate of PED > 49%. PED remained the more cost-effective strategy when the morbidity and mortality of PED increased by <55% and when those of SAC decreased by <37%. SAC only became cost-effective when the total cost of PED is >$73000 more expensive than the total cost of SAC.
With increasing use of PED for treatment of small unruptured anterior circulation aneurysms, our study indicates that PED is cost-effective relative to stent coiling irrespective of aneurysm size. This is due to lower aneurysm recurrence rate, as well as better health outcomes.
支架辅助弹簧圈栓塞术（SAC）和Pipeline 栓塞装置（PED；美敦力公司）血流导向治疗均已被证实用于治疗小（<10mm）未破裂动脉瘤是安全且有效的。然而，这些不同技术的经济影响尚未确定。
分析支架辅助弹簧圈栓塞术和 PED 血流导向治疗的成本效益，包括手术成本、长期结果和动脉瘤复发。
采用决策分析研究，采用 Markov 建模方法模拟 SAC 或 PED 治疗 5mm 和 7mm 大小未破裂动脉瘤的患者。输入概率来自先前的文献，进行了单因素、双因素和概率敏感性分析（PSA）。
在基础病例计算和 PSA 中，PED 在有或没有考虑间接成本的情况下，对于两个大小组均为优势策略。单因素敏感性分析表明，当 SAC 的再治疗率从 0%变化到 50%时，结论仍然稳健，仅当 PED 的再治疗率>49%时才会改变。当 PED 的发病率和死亡率增加<55%且 SAC 的发病率和死亡率降低<37%时，PED 仍然是更具成本效益的策略。只有当 PED 的总成本比 SAC 的总成本高出$73000 时，SAC 才具有成本效益。
随着 PED 在治疗小型未破裂前循环动脉瘤中的应用增加，我们的研究表明，无论动脉瘤大小如何，PED 相对于支架圈闭都是具有成本效益的。这是由于较低的动脉瘤复发率以及更好的健康结果。
