Academy of Postgraduate Medical Education, Maastricht University Medical Center, Maastricht, the Netherlands -
School of Health Professions Education, University of Maastricht, Maastricht, the Netherlands -
J Neurosurg Sci. 2023 Feb;67(1):18-25. doi: 10.23736/S0390-5616.21.05503-X. Epub 2022 Feb 11.
There are two treatment modalities for aneurysmal subarachnoid hemorrhage: endovascular treatment (EVT) and neurosurgical clipping. Results of economic evaluations are needed to gain insight into the relationship between clinical effectiveness and costs of these treatment modalities. This important information can inform both clinical decision-making processes and policymakers in facilitating Value-Based Healthcare.
Databases (PubMed, Embase, Cochrane Library, the Centre for Reviews and Dissemination, EBSCO, and Web of Science) were searched for studies published until October 2020 that had performed economic evaluations in aneurysmal subarachnoid hemorrhage patients by comparing EVT with neurosurgical clipping. The quality of reporting and methodology of these evaluations was assessed using the associated instruments (i.e. CHEERS statement and CHEC-list, respectively).
A total of 6 studies met the inclusion criteria. All included studies reported both effects and costs, however five did not relate effects to costs. Only one study related effects directly to costs, thus conducted a full economic evaluation. The reporting quality scored 81% and the methodological quality scored 30%.
The quality of published cost-effectiveness studies on the treatment of aneurysmal subarachnoid hemorrhage is poor. Six studies reported both outcomes and costs, however only one study performed a full economic evaluation comparing EVT to neurosurgical clipping. Although the reporting quality was sufficient, the methodological quality was poor. Further research that relates health-related quality of life measures to costs of EVT and neurosurgical clipping is required - specifically focusing on both reporting and methodological quality. Different subgroup analyses and modeling could also enhance the findings.
对于蛛网膜下腔出血的动脉瘤，有两种治疗方法：血管内治疗（EVT）和神经外科夹闭。需要经济评估的结果来深入了解这些治疗方法的临床效果和成本之间的关系。这些重要信息可以为临床决策过程和决策者提供信息，以促进基于价值的医疗保健。
截至 2020 年 10 月，通过比较 EVT 与神经外科夹闭，在蛛网膜下腔出血患者中进行经济评估的研究，在数据库（PubMed、Embase、Cochrane 图书馆、评估与传播中心、EBSCO 和 Web of Science）中进行了搜索。使用相关工具（即 CHEERS 声明和 CHEC 清单）评估这些评估的报告质量和方法学。
共有 6 项研究符合纳入标准。所有纳入的研究均报告了效果和成本，但有 5 项研究未将效果与成本联系起来。只有一项研究将效果直接与成本相关联，因此进行了全面的经济评估。报告质量得分为 81%，方法学质量得分为 30%。
发表的关于蛛网膜下腔出血治疗的成本效益研究的质量较差。六项研究报告了结果和成本，但只有一项研究对 EVT 与神经外科夹闭进行了全面的经济评估。尽管报告质量足够，但方法学质量较差。需要进一步研究将 EVT 和神经外科夹闭的健康相关生活质量测量与成本联系起来 - 特别是要关注报告和方法学质量。不同的亚组分析和建模也可以增强研究结果。
