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Journal of Neurosurgical Sciences 1998 June;42(2):69-78

lingua: Inglese

A ­cost-effec­tive­ness anal­y­sis on dif­fer­ent sur­gi­cal strat­e­gies ­for intra­cra­ni­al aneu­rysms

Gaetani P. 1, Rodriguez y Baena R. 1, Klersy C. 2, Adinolfi D. 3, Infuso L. 3

1 Department of Neurosurgery, Istituto Clinico Humanitas, Rozzano, Milan;
2 Scientific Direction , IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy;
3 Section of Neurosurgery, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy


Background. Economical stud­ies on sur­gery of intra­cra­ni­al aneu­rysms ­have con­sid­ered ­only ­the sig­nif­i­cant ben­e­fit of sur­gi­cal ­approach on unrup­tured aneu­rysms ­and no stud­ies ­have ­been per­formed com­par­ing ­cost/ben­e­fit anal­y­sis of ear­ly vs ­delayed sur­gery. The ­present ­study ­was ret­ro­spec­tive­ly per­formed in ­order to ver­i­fy wheth­er dif­fer­ent treat­ment ­options in aneu­rysm sur­gery ­have a dif­fer­ent ­cost/ben­e­fit ­ratio.
Methods. We ­have ana­lysed a ­series of 137 ­patients ­which under­went sur­gery ­for intra­cra­ni­al aneu­rysms (21 unrup­tured aneu­rysms, 56 ear­ly sur­gery ­and 60 ­delayed sur­gery). In ­the anal­y­sis we ­assumed ­that ­each ­state of an oper­at­ed ­patient ­has an ­assigned qual­ity of ­life val­ue ­and an asso­ciat­ed med­i­cal ­cost. We ­expressed ­the out­come of ­each ­patient as ­the expect­ed ­length of sur­vi­val adjust­ed ­for qual­ity, ­and ­referred to it as “qual­ity-adjust­ed ­life ­years” (­QALY). We con­sid­ered ­for ­each ­patient ­the ­direct ­cost of Hospitalisation (­obtained ­from ­DRG reim­burse­ment), ­the Rehabilitation ­cost ­and ­the cor­rec­tion ­due to ­QALY adjust­ed ­for ­age ­and def­i­cit.
Results. Significantly high­er ­costs ­are report­ed in ­patients ­which ­present as ­major com­pli­ca­tion ­the hydro­ceph­a­lus ­and ­which ­are treat­ed ­with nimod­i­pine; more­over, ­the ­costs ­for ­patients oper­at­ed ­for unrup­tured aneu­rysms is sig­nif­i­cant­ly low­er ­than ­that of ­patients ­which pre­sent­ed ­with ­SAH. Meanwhile, ­the aver­age ­QALY adjust­ed ­for ­post-oper­a­tive neu­ro­log­i­cal def­i­cit at ­three ­months fol­low-up is high­er in ­patients oper­at­ed ­for unrup­tured aneu­rysms ­than in ­patients oper­at­ed ­after ­SAH. The ­cost-effec­tive­ness of dif­fer­ent treat­ment strat­e­gies ­did ­not sig­nif­i­cant­ly dif­fer con­sid­er­ing ­age ­and neu­ro­log­i­cal def­i­cit adjust­ment; ­thus, ­after ­SAH, ­the ­choice of ear­ly or ­delayed sur­gery ­may ­depend on clin­i­cal ­and logis­tic con­di­tions relat­ed to ­the neu­ro­sur­gi­cal depart­ment ­and ­its organ­isa­tion, ­because ­there is no sig­nif­i­cant eco­nom­i­cal advan­tage lead­ing to rec­om­mend ear­ly ver­sus ­delayed sur­gery.
Conclusions. In con­clu­sion ­the ­present ­data sug­gest ­that a ­decreased ­length of hos­pi­tal­isa­tion ­and a ­decreased ­cost ­for treat­ment of unrup­tured aneu­rysms ­should jus­ti­fy a ­more rig­or­ous pre­ven­tive screen­ing ­with avail­able ­non inva­sive neu­ro­im­ag­ing tech­niques.

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