132 Chapter 8 Abstract Purpose: Intra-arterial digital subtraction angiography (DSA) is the standard of reference for detection of ruptured intracranial aneurysms and determination of suitable treatment. Contrast enhanced magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) are non-invasive alternatives. If imaging deems no feasibility of endovascular treatment, surgical clipping is an alternative with higher costs and less favorable outcome. Goal of this study was to compare the cost-effectiveness of MRA, CTA and DSA respectively in non-traumatic subarachnoid hemorrhage. Materials and Methods: A decision model was used to calculate costs and benefits (in quality-adjusted life-years QALYs) that accrued to cohorts of 1000 patients during one year. Costs and characteristics of diagnostic tests, therapy, patients’ quality of life and associated costs were taken into account. In a scenario analysis a strategy was examined where in each patient, for whom coiling was not deemed feasible on the basis of CTA or MRA, DSA was performed. Results DSA was the most effective diagnostic option, yielding on average 0.6039 QALYs (SD 0.0148) per patient, followed by CTA 0.5983 QALYs (SD 0.0146) and MRA 0.5947 QALYs (SD 0.0146). Cost was lowest for DSA (€39,808; SD €1,384), followed by CTA (€40,748; SD €1,510) and MRA (€41,814; SD €1,644). The strategy that included DSA for each patient for whom coiling was not deemed feasible showed CTA being most cost-effective. Conclusion: DSA is more cost-effective than MRA and CTA. A strategy where CTA is followed by DSA if aneurysm coiling is not deemed feasible, is found to be the most cost-effective option.
proefschrit Van Zwam inhoud met kaft en stellingen.indd
To see the actual publication please follow the link above