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首页> 外文期刊>Neurosurgical focus >Pipeline embolization device versus coiling for the treatment of large and giant unruptured intracranial aneurysms: a cost-effectiveness analysis
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Pipeline embolization device versus coiling for the treatment of large and giant unruptured intracranial aneurysms: a cost-effectiveness analysis

机译：管道栓塞装置与盘绕装置治疗大而巨大的未破裂颅内动脉瘤：成本效益分析

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OBJECTIVE Rupture of large or giant intracranial aneurysms leads to significant morbidity, mortality, and health care costs. Both coiling and the Pipeline embolization device (PED) have been shown to be safe and clinically effective for the treatment of unruptured large and giant intracranial aneurysms; however, the relative cost-to-outcome ratio is unknown. The authors present the first cost-effectiveness analysis to compare the economic impact of the PED compared with coiling or no treatment for the endovascular management of large or giant intracranial aneurysms. METHODS A Markov model was constructed to simulate a 60-year-old woman with a large or giant intracranial aneurysm considering a PED, endovascular coiling, or no treatment in terms of neurological outcome, angiographic outcome, retreatment rates, procedural and rehabilitation costs, and rupture rates. Transition probabilities were derived from prior literature reporting outcomes and costs of PED, coiling, and no treatment for the management of aneurysms. Cost-effectiveness was defined, with the incremental cost-effectiveness ratios (ICERs) defined as difference in costs divided by the difference in quality-adjusted life years (QALYs). The ICERs RESULTS The base-case model demonstrated lifetime QALYs of 12.72 for patients in the PED cohort, 12.89 for the endovascular coiling cohort, and 9.7 for patients in the no-treatment cohort. Lifetime rehabilitation and treatment costs were $59,837.52 for PED; $79,025.42 for endovascular coiling; and $193,531.29 in the no-treatment cohort. Patients who did not undergo elective treatment were subject to increased rates of aneurysm rupture and high treatment and rehabilitation costs. One-way sensitivity analysis demonstrated that the model was most sensitive to assumptions about the costs and mortality risks for PED and coiling. Probabilistic sampling demonstrated that PED was the cost-effective strategy in 58.4% of iterations, coiling was the cost-effective strategy in 41.4% of iterations, and the no-treatment option was the cost-effective strategy in only 0.2% of iterations. CONCLUSIONS The authors’ cost-effective model demonstrated that elective endovascular techniques such as PED and endovascular coiling are cost-effective strategies for improving health outcomes and lifetime quality of life measures in patients with large or giant unruptured intracranial aneurysm.
机译：目的颅内或大动脉瘤破裂会导致高发病率，死亡率和医疗保健费用。盘绕术和管道栓塞术（PED）都已被证明对未破裂的大而巨大的颅内动脉瘤的治疗是安全且临床有效的。但是，相对的成本收益比是未知的。作者提出了第一个成本效益分析，以比较PED与大盘或巨大颅内动脉瘤的腔内治疗相比，采用盘绕或不治疗的经济影响。方法建立马尔可夫模型，以模拟一名60岁女性，颅内动脉瘤较大或巨大，考虑到PED，血管内盘绕或不进行神经学预后，血管造影结果，再治疗率，手术和康复费用以及破裂率。转移的可能性来自先前的文献报道，这些文献报道了PED的结果和成本，盘绕，以及未治疗动脉瘤的治疗方法。定义了成本效益，将增量成本效益比（ICER）定义为成本差异除以质量调整生命年（QALY）的差异。 ICERs结果基本案例模型显示，PED队列患者的终生QALY为12.72，血管内盘旋队列为12.89，无治疗队列为9.7。 PED的终生康复和治疗费用为59,837.52美元; $ 79,025.42用于血管内盘绕;以及$ 193,531.29（无治疗组）。未接受选择性治疗的患者的动脉瘤破裂率增加，治疗和康复费用也较高。单向敏感性分析表明，该模型对有关PED和卷取的成本和死亡风险的假设最为敏感。概率抽样表明，PED是58.4％的迭代中的成本有效策略，盘绕是41.4％的迭代中的成本有效策略，而无处理选项是仅0.2％的迭代中的成本有效策略。结论作者的成本效益模型表明，选择性血管内技术（如PED和血管内盘绕术）是改善大型或巨大颅内动脉瘤破裂患者的健康结局和终生生活质量指标的经济有效策略。

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