Salih Mira, Salem Mohamed, Moore Justin, Thomas Ajith J, Ogilvy Christopher S
J Neurosurg. 2022 Oct 7;138(5):1366-1373. doi: 10.3171/2022.8.JNS221053. Print 2023 May 1.
Unruptured intracranial aneurysms are frequently detected during routine clinical diagnostic processes. A significant portion are small aneurysms less than 5 mm in diameter. While follow-up of patients with small aneurysms has been advocated, the cost-effectiveness of such care and the optimal follow-up interval remain unknown. This study aimed to explore the most cost-effective follow-up interval for small (< 5 mm) unruptured intracranial aneurysms.
A decision analysis study was performed using a Markov model with Monte Carlo simulations to simulate patients undergoing follow-up by MRA at different time intervals (1-, 2-, 3-, 5-, and 7-year intervals) for small (< 5 mm) unruptured intracranial aneurysms. Input data for the model were extracted from the current literature, primarily meta-analyses. Probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of the model.
Given the current literature and the model in this study, following up every 2 years with noninvasive imaging is the most cost-effective strategy (cost $126,996, effectiveness 21.9 quality-adjusted life-years), showing the highest net monetary benefit. The conclusion remains robust in probabilistic and deterministic sensitivity analyses. As the annual growth risk of small aneurysms and annual rupture risk of growing aneurysms increase, following up every year is optimal. When the cost for follow-up with MRA is less than $2223, following up every year is cost-effective.
The most cost-effective follow-up strategy for small (< 5 mm) unruptured aneurysms using MRA is following up every 2 years. More frequent follow-up strategies or prompt preventive treatment would be more appropriate in patients with higher risk factors for growth and aneurysm rupture.
颅内未破裂动脉瘤常在常规临床诊断过程中被发现。其中很大一部分是直径小于5毫米的小动脉瘤。虽然提倡对小动脉瘤患者进行随访，但这种治疗的成本效益以及最佳随访间隔仍不清楚。本研究旨在探讨小（<5毫米）颅内未破裂动脉瘤最具成本效益的随访间隔。
采用马尔可夫模型和蒙特卡洛模拟进行决策分析研究，以模拟对小（<5毫米）颅内未破裂动脉瘤患者在不同时间间隔（1年、2年、3年、5年和7年间隔）进行磁共振血管造影（MRA）随访的情况。模型的输入数据主要从当前文献（主要是荟萃分析）中提取。进行概率性和确定性敏感性分析以评估模型的稳健性。
根据本研究中的当前文献和模型，每2年进行一次无创成像随访是最具成本效益的策略（成本为126,996美元，效果为21.9个质量调整生命年），显示出最高的净货币效益。在概率性和确定性敏感性分析中，该结论仍然稳健。随着小动脉瘤的年生长风险和生长中动脉瘤的年破裂风险增加，每年随访是最佳选择。当MRA随访成本低于2223美元时，每年随访具有成本效益。
使用MRA对小（<5毫米）未破裂动脉瘤进行随访的最具成本效益的策略是每两年随访一次。对于生长和动脉瘤破裂风险较高的患者，更频繁的随访策略或及时的预防性治疗可能更合适。
