COST-EFFECTIVENESS OF ENDOVASCULAR COILING VERSUS SURGICAL CLIPPING IN RUPTURED CEREBRAL ARTERY ANEURYSM

Abstract

Background: Ruptured cerebral aneurysm is a catastrophic stroke. The surgical clipping and endovascular coiling are standard treatments to prevent rebleeding. There are strong evidences to support that endovascular coiling offers better outcome over surgical clipping. However the cost of coiling procedure weight against its clinical benefit. Objective: To compare the cost-effectiveness of endovascular coiling to surgical clipping in ruptured cerebral aneurysm patients in context of Thai health economic system. Study design: Markov model analytic Setting: King Chulalongkorn Memorial Hospital Research methodology: The Markov model was used to estimate the relevant treatment costs and outcome of ruptured cerebral aneurysm patients. The model input were retrieved from systematic reviews. Outcomes measurement, the clinical outcomes were converted to health outcomes by using Thai version EQ-5D questionnaire. Point of view is payer viewpoint. The data were collected from the medical records of the patients, who were admitted at King Chulalongkorn Memorial hospital with ruptured cerebral aneurysms from September, 1, 2007 to August, 31, 2009. The uncertainty analysis was performed by Probabilistic Sensitivity Analysis (PSA). Results: The endovascular coiling yield 0.85 QALYs gained compared to surgical clipping (11.32 QALYs ; 10.47 QALYs). The surgical clipping provided better cost-effectiveness ratio compared to endovascular coiling (305,694versus 414,538Thai baht(THB) per QALY). The Incremental cost-effectiveness ratio (ICER ) per QALY of endovascular coiling compared to surgical clipping is 1,755,912THB. Conclusion: It was found that the surgical clipping is cost-effective at Thai willing to pay (WTP) threshold of 160,000 THB per QALY gained, with probability 100%. To comply the Thai WTP threshold the endovascular coiling cost should be 29 percent less.