Department of Surgery, Khon Kaen University Faculty of Medicine, Khon Kaen, Thailand.
Department of Surgery, Khon Kaen University Faculty of Medicine, Khon Kaen, Thailand
J Neurointerv Surg. 2022 Sep;14(9):942-947. doi: 10.1136/neurintsurg-2021-017970. Epub 2021 Sep 20.
For patients with aneurysmal subarachnoid hemorrhage (aSAH), the Universal Coverage Scheme in Thailand covers the full costs of surgical and endovascular procedures except for those of embolization coils and assisting devices. Costs and effectiveness were compared between endovascular coiling and neurosurgical clipping to inform reimbursement policy decisions.
Costs and quality-adjusted life years (QALYs) were compared between coiling and clipping using the decision tree and Markov models. Mortality and functional outcomes of clipping were derived from national and hospital databases, and relative efficacies of coiling were obtained from meta-analyses of randomized controlled trials. Risks of rebleeding were abstracted from the International Subarachnoid Aneurysm Trial. Costs of the primary treatments, retreatments and follow-up care as well as utilities were obtained from hospital-based data. Non-health and indirect costs were abstracted from standard cost lists.
Coiling and clipping contributed 10.59 and 9.28 QALYs to patients aged in their 50s. Under the societal and healthcare perspectives, the incremental costs incurred by coiling compared with clipping were US$1923 and $4343, respectively, which were equal to the incremental cost-effectiveness ratio of US$1470 and $3321 per QALY gained, respectively. Coiling became a cost-saving option when the costs of coil devices were reduced by 65.7%. At the country's cost-effectiveness threshold of US$5156, the probability of coiling being cost-effective was 71.3% and 65.6%, under the societal and healthcare perspectives, respectively.
Endovascular treatment for aSAH is cost-effective and this evidence supports coverage by national insurance.
在泰国，全民医疗保险覆盖了除栓塞线圈和辅助器械之外的所有开颅夹闭术和血管内介入治疗的费用。本研究旨在比较血管内介入治疗和开颅夹闭术的成本和效果，为医保报销政策提供依据。
采用决策树和马尔可夫模型比较了血管内介入治疗和开颅夹闭术的成本和质量调整生命年（QALY）。开颅夹闭术的死亡率和功能结局数据来自国家和医院数据库，血管内介入治疗的相对疗效数据来自随机对照试验的荟萃分析。再出血风险数据从国际蛛网膜下腔出血试验中提取。主要治疗、治疗后随访及相关效用值等成本数据来自医院数据。非健康相关成本和间接成本数据来自标准成本清单。
血管内介入治疗和开颅夹闭术分别为 50 多岁患者带来 10.59 和 9.28 个 QALY。在社会和医疗保健视角下，血管内介入治疗比开颅夹闭术分别多花费 1923 美元和 4343 美元，增量成本效益比分别为 1470 美元和 3321 美元/QALY。当线圈装置成本降低 65.7%时，血管内介入治疗成为一种节省成本的选择。在国家设定的 5156 美元成本效益阈值下，血管内介入治疗在社会和医疗保健视角下具有成本效益的概率分别为 71.3%和 65.6%。
血管内介入治疗治疗 aSAH 具有成本效益，该证据支持国家保险覆盖。
