Treatment of Unruptured Intracranial Aneurysms: Decision and Cost-effectiveness Analysis

Abstract

For 50-year-old patients, treatment of aneurysms that are small (<7 mm), that are located in the cavernous carotid artery, or that are large (>or=25 mm) and located in the posterior circulation is ineffective or not cost-effective.

Cost-effectiveness of preventive treatment of intracranial aneurysms

“…Several such decision and cost-effectiveness analyses have been performed. [7][8][9][10][11] However, in these analyses, comparisons among surgical clipping, endovascular coiling, and no treatment were based on earlier estimates of complications risks or data derived from the ISUIA only. 4 Furthermore, the risk of formation and rupture of recurrent and de novo aneurysms were not included in these models.…”

“…7,8 Another study reported that treatment was cost-effective for aneurysms that are Ն13 mm located in the anterior circulation and 7-to 12-mm aneurysms located in the posterior location, i.e., aneurysms with a yearly rupture rate above 3%. 11 However, those findings were based on earlier estimates of complications, risks, or results of the prospective ISUIA data only. 4 …”

“…5,6 Furthermore, in previous cost-effectiveness analyses of unruptured aneurysm treatment, there was a tendency for endovascular treatment to be more cost-effective than surgical treatment. 9,11 However, these studies did not consider the costs of additional treatments and therefore underestimated the costs of endovascular treatment. In addition, more accurate cost estimates for surgical and endovascular treatments (in particular the higher costs of coils) have become available.…”

Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

“…52 Data were obtained from the prospective arm of the ISUIA and from large meta-analyses. Fifty years of age was chosen for their model because it approximated the mean age in the ISUIA trial.…”

Unruptured Intracranial Aneurysms: Some Questions Answered, Many Questions Remain

“…Mathematical modeling of aneurysm natural history and management risks have been conflicting, with some suggesting that small unruptured aneurysms may not benefit from a procedure 18 . Another decision and cost-effectiveness analyses suggested that treatment of very small aneurysms, <7 mm in diameter, is not cost-effective 19 . The early retrospective natural history data from ISUIA contributed to a 2000 American Heart Association guideline 8 which suggested that repair of small UIAs in patients with no history of SAH could "no longer be generally advocated".…”