REVIEW  NEUROSURGICAL SYSTEMATIC REVIEWS AND META-ANALYSES FOR A DAILY PRACTICE - PART III 

Journal of Neurosurgical Sciences 2023 February;67(1):18-25

DOI: 10.23736/S0390-5616.21.05503-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Endovascular treatment and neurosurgical clipping in subarachnoid hemorrhage: a systematic review of economic evaluations

Lotte A. BOCK ^{1, 2} ✉, Cindy Y. NOBEN ¹, Walther N. van MOOK ^{1, 2, 3}, Inger R. de RIDDER ⁴, Wim H. van ZWAM ⁵, Hanna E. SCHENCK ⁶, Roel H. HAEREN ⁶, Brigitte A. ESSERS ⁷

¹ Academy of Postgraduate Medical Education, Maastricht University Medical Center, Maastricht, the Netherlands; ² School of Health Professions Education, University of Maastricht, Maastricht, the Netherlands; ³ Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; ⁴ Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands; ⁵ Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; ⁶ Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands; ⁷ Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands

INTRODUCTION: There are two treatment modalities for aneurysmal subarachnoid hemorrhage: endovascular treatment (EVT) and neurosurgical clipping. Results of economic evaluations are needed to gain insight into the relationship between clinical effectiveness and costs of these treatment modalities. This important information can inform both clinical decision-making processes and policymakers in facilitating Value-Based Healthcare.
EVIDENCE ACQUISITION: Databases (PubMed, Embase, Cochrane Library, the Centre for Reviews and Dissemination, EBSCO, and Web of Science) were searched for studies published until October 2020 that had performed economic evaluations in aneurysmal subarachnoid hemorrhage patients by comparing EVT with neurosurgical clipping. The quality of reporting and methodology of these evaluations was assessed using the associated instruments (i.e. CHEERS statement and CHEC-list, respectively).
EVIDENCE SYNTHESIS: A total of 6 studies met the inclusion criteria. All included studies reported both effects and costs, however five did not relate effects to costs. Only one study related effects directly to costs, thus conducted a full economic evaluation. The reporting quality scored 81% and the methodological quality scored 30%.
CONCLUSIONS: The quality of published cost-effectiveness studies on the treatment of aneurysmal subarachnoid hemorrhage is poor. Six studies reported both outcomes and costs, however only one study performed a full economic evaluation comparing EVT to neurosurgical clipping. Although the reporting quality was sufficient, the methodological quality was poor. Further research that relates health-related quality of life measures to costs of EVT and neurosurgical clipping is required - specifically focusing on both reporting and methodological quality. Different subgroup analyses and modeling could also enhance the findings.

KEY WORDS: Cost-benefit analysis; Endovascular procedures; Neurosurgical procedures; Subarachnoid hemorrhage