Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
Clin Neuroradiol. 2023 Dec;33(4):1075-1086. doi: 10.1007/s00062-023-01311-0. Epub 2023 Jun 27.
Information about the cost-effectiveness of a certain treatment is relevant for decision-making and healthcare providers. This study compares the cost-effectiveness of the novel Woven Endobridge (WEB) for intracranial aneurysm treatment with conventional coiling and stent-assisted coiling (SAC) from the perspective of the German Statutory Health Insurance.
A patient-level simulation was constructed to simulate 55-year-old patients with an unruptured middle cerebral artery aneurysm (size: 3-11 mm) considering WEB treatment, coiling or SAC in terms of morbidity, angiographic outcome, retreatment, procedural and rehabilitation costs and rupture rates. Incremental cost-effectiveness ratios (ICERs) were calculated as costs per quality-adjusted life years (QALYs) and costs per year with neurologic morbidity avoided. Uncertainty was explored with deterministic and probabilistic sensitivity analyses. The majority of data were obtained from prospective multi-center studies and meta-analyses of non-randomized studies.
In the base case, lifetime QALYs were 13.24 for the WEB, 12.92 for SAC and 12.68 for coiling. Lifetime costs were 20,440 € for the WEB, 23,167 € for SAC, and 8200 € for coiling. Compared to coiling, the ICER for the WEB was 21,826 €/QALY, while SAC was absolutely dominated by WEB. Probabilistic sensitivity analysis revealed that at a willingness-to-pay of ≥ 30,000 €/QALY, WEB was the preferred treatment. Deterministic sampling showed that the discount rate, material costs and retreatment rates had the largest impact on the ICERs.
The novel WEB showed at least comparable cost-effectiveness to SAC for treatment of broad-based unruptured aneurysms. Considering all three modalities, coiling had the least costs; however this modality is often not appropriate for the treatment of wide-necked aneurysms.
特定治疗方法的成本效益信息对决策和医疗保健提供者来说至关重要。本研究从德国法定健康保险的角度比较了新型编织式颅内血管修复装置（WEB）治疗颅内动脉瘤与传统的线圈栓塞和支架辅助栓塞（SAC）的成本效益。
构建了一个患者水平的模拟模型，以模拟考虑 WEB 治疗、线圈栓塞或 SAC 的 55 岁未破裂大脑中动脉动脉瘤（大小：3-11mm）患者的发病率、血管造影结果、再治疗、程序和康复费用以及破裂率。增量成本效益比（ICER）以每质量调整生命年（QALY）的成本和每避免神经功能障碍年的成本来计算。通过确定性和概率敏感性分析来探索不确定性。大多数数据来自前瞻性多中心研究和非随机研究的荟萃分析。
在基础情况下，WEB 的终生 QALYs 为 13.24，SAC 为 12.92，线圈栓塞为 12.68。WEB 的终生费用为 20440 欧元，SAC 为 23167 欧元，线圈栓塞为 8200 欧元。与线圈栓塞相比，WEB 的 ICER 为 21826 欧元/QALY，而 SAC 则完全被 WEB 所主导。概率敏感性分析表明，在支付意愿≥30000 欧元/QALY 时，WEB 是首选治疗方法。确定性抽样表明，折扣率、材料成本和再治疗率对 ICER 影响最大。
新型 WEB 治疗广泛基底未破裂动脉瘤的成本效益至少与 SAC 相当。考虑到所有三种治疗方式，线圈栓塞的成本最低；然而，这种方式通常不适合治疗宽颈动脉瘤。
