Faculty of Medicine, Department of Medicine, Imperial College London, London, UK.
Department of Metabolism, Digestion and Reproduction, Imperial College Healthcare Trust, London, UK.
Neurosurg Rev. 2022 Oct;45(5):3259-3269. doi: 10.1007/s10143-022-01854-9. Epub 2022 Sep 3.
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).
血管内栓塞（EV）已在系统评价和荟萃分析中被确定，与神经外科夹闭（NC）相比，在治疗破裂性颅内动脉瘤引起的蛛网膜下腔出血时具有更有利的临床结果。已经对这两种干预措施进行了成本效益分析，但尚未发表成本效用分析。本系统评价旨在对英国这两种治疗方法的相对效用结果和成本进行经济分析。在 1 年的分析时间内，从国民保健制度（NHS）的角度进行了成本效用分析。结果来自随机国际蛛网膜下腔出血试验（ISAT），并以患者改良 Rankin 量表（mRS）等级来衡量，这是一种 6 分残疾量表，旨在量化中风后患者的功能结果。mRS 评分与欧洲五维健康量表（EQ-5D）相对应，每个状态都分配了一个加权效用值，然后将其转换为质量调整生命年（QALY）。使用不同的效用维度进行了敏感性分析，以确定如果使用不同的输入变量，增量成本效益比（ICER）是否会发生变化。成本以英镑（£）计量，并按 3.5%贴现至 2020/2021 年的价格。成本效用分析显示，当使用 EV 而不是 NC 时，每获得一个质量调整生命年（QALY）的成本效益比（ICER）为-£144,004。在 NICE 的最高意愿支付（WTP）阈值£30,000 下，EC 比 NC 带来了 7934.63 英镑的货币净收益（MNB）和 0.264 的健康净收益（HNB）。在 NICE 的较低意愿支付（WTP）阈值£20,000 下，EC 比 NC 带来了 7478.63 英镑的货币净收益（MNB）和 0.374 的健康净收益（HNB）。EV 比 NC 更具“成本效益”，ICER 在成本效益平面的右下象限-表明它以较低的成本提供了更大的收益。这一点得到了 ICER 低于 NICE 的£20,000-£30,000 每 QALY 阈值的支持，并且 MNB 和 HNB 都具有正值（>0）。
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