Aneurysm occlusion in elderly patients with aneurysmal subarachnoid haemorrhage: A cost-utility analysis

H. Koffijberg*, E. Buskens, G.J.E. Rinkel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
27 Downloads (Pure)

Abstract

Background: Aneurysm occlusion after subarachnoid haemorrhage (SAH) aims to improve outcome by reducing the rebleeding risk. With increasing age, overall prognosis decreases, and the complications of aneurysm occlusion increase. The balance of risks for aneurysm occlusion in elderly SAH patients in different age categories and clinical conditions is unknown.

Methods: A Markov model was used to evaluate quality-adjusted life years (QALY), additional costs and incremental cost-effectiveness ratios (ICER) of aneurysm occlusion in 192 patient subgroups, based on age, gender, neurological condition at admission, time since SAH, and aneurysm size and location. Probabilistic sensitivity analyses were performed.

Results: For patients admitted in poor condition ≥10 days after SAH, and patients older than 80 years, admitted in poor condition admitted ≥4 days after SAH, occlusion implied QALY loss and increased costs. Only for women younger than 79 and men younger than 74 years admitted in good condition within 4 days did the ICER of occlusion fall below €50 000 per QALY. Occlusion was beneficial and cost-saving in women aged 74 years or younger admitted in good condition within 4 days with a small posterior circulation aneurysm.

Conclusions: Aneurysm occlusion is harmful in some subgroups of elderly patients and beneficial in others. It is cost-effective only in specific subgroups that comprise a large part of the patients encountered in clinical practice. Beyond the age of 80 years, the balance between risks and benefits is often no longer positive for occlusion, and it should only be considered if the predicted life expectancy leaves margin for benefit.

Original languageEnglish
Pages (from-to)718-727
Number of pages10
JournalJournal of neurology, neurosurgery and psychiatry
Volume82
Issue number7
DOIs
Publication statusPublished - Jul 2011

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Subarachnoid Hemorrhage
Cost-Benefit Analysis
Aneurysm
Quality-Adjusted Life Years
Costs and Cost Analysis
Life Expectancy
Costs

Cite this

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title = "Aneurysm occlusion in elderly patients with aneurysmal subarachnoid haemorrhage: A cost-utility analysis",
abstract = "Background: Aneurysm occlusion after subarachnoid haemorrhage (SAH) aims to improve outcome by reducing the rebleeding risk. With increasing age, overall prognosis decreases, and the complications of aneurysm occlusion increase. The balance of risks for aneurysm occlusion in elderly SAH patients in different age categories and clinical conditions is unknown.Methods: A Markov model was used to evaluate quality-adjusted life years (QALY), additional costs and incremental cost-effectiveness ratios (ICER) of aneurysm occlusion in 192 patient subgroups, based on age, gender, neurological condition at admission, time since SAH, and aneurysm size and location. Probabilistic sensitivity analyses were performed.Results: For patients admitted in poor condition ≥10 days after SAH, and patients older than 80 years, admitted in poor condition admitted ≥4 days after SAH, occlusion implied QALY loss and increased costs. Only for women younger than 79 and men younger than 74 years admitted in good condition within 4 days did the ICER of occlusion fall below €50 000 per QALY. Occlusion was beneficial and cost-saving in women aged 74 years or younger admitted in good condition within 4 days with a small posterior circulation aneurysm.Conclusions: Aneurysm occlusion is harmful in some subgroups of elderly patients and beneficial in others. It is cost-effective only in specific subgroups that comprise a large part of the patients encountered in clinical practice. Beyond the age of 80 years, the balance between risks and benefits is often no longer positive for occlusion, and it should only be considered if the predicted life expectancy leaves margin for benefit.",
author = "H. Koffijberg and E. Buskens and G.J.E. Rinkel",
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doi = "10.1136/jnnp.2009.185660",
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Aneurysm occlusion in elderly patients with aneurysmal subarachnoid haemorrhage : A cost-utility analysis. / Koffijberg, H.; Buskens, E.; Rinkel, G.J.E.

In: Journal of neurology, neurosurgery and psychiatry, Vol. 82, No. 7, 07.2011, p. 718-727.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Aneurysm occlusion in elderly patients with aneurysmal subarachnoid haemorrhage

T2 - A cost-utility analysis

AU - Koffijberg, H.

AU - Buskens, E.

AU - Rinkel, G.J.E.

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N2 - Background: Aneurysm occlusion after subarachnoid haemorrhage (SAH) aims to improve outcome by reducing the rebleeding risk. With increasing age, overall prognosis decreases, and the complications of aneurysm occlusion increase. The balance of risks for aneurysm occlusion in elderly SAH patients in different age categories and clinical conditions is unknown.Methods: A Markov model was used to evaluate quality-adjusted life years (QALY), additional costs and incremental cost-effectiveness ratios (ICER) of aneurysm occlusion in 192 patient subgroups, based on age, gender, neurological condition at admission, time since SAH, and aneurysm size and location. Probabilistic sensitivity analyses were performed.Results: For patients admitted in poor condition ≥10 days after SAH, and patients older than 80 years, admitted in poor condition admitted ≥4 days after SAH, occlusion implied QALY loss and increased costs. Only for women younger than 79 and men younger than 74 years admitted in good condition within 4 days did the ICER of occlusion fall below €50 000 per QALY. Occlusion was beneficial and cost-saving in women aged 74 years or younger admitted in good condition within 4 days with a small posterior circulation aneurysm.Conclusions: Aneurysm occlusion is harmful in some subgroups of elderly patients and beneficial in others. It is cost-effective only in specific subgroups that comprise a large part of the patients encountered in clinical practice. Beyond the age of 80 years, the balance between risks and benefits is often no longer positive for occlusion, and it should only be considered if the predicted life expectancy leaves margin for benefit.

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JO - Journal of neurology, neurosurgery and psychiatry

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SN - 0022-3050

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