Completion angiography for surgically treated cerebral aneurysms: an economic analysis

Area of Science:

• Neurosurgery
• Medical Economics
• Radiology

Background:

• Cerebral aneurysms require clipping, a procedure often followed by completion angiography to ensure success.
• Evaluating the cost-effectiveness of different angiography strategies is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To compare the cost-effectiveness of various completion angiography strategies following cerebral aneurysm clipping.

Main Methods:

• A comprehensive literature search identified outcome probabilities and costs for different strategies.
• A Markov cost-effectiveness model was employed to compare quality-adjusted life-years and costs.
• Sensitivity analyses and Monte Carlo simulations were utilized to assess model variability.

Main Results:

• Routine intraoperative angiography was found to be more cost-effective than selective intraoperative angiography (less costly, more effective).
• Routine postoperative angiography was the least cost-effective strategy.
• Selective angiography may be considered in centers with exceptionally low rates of clip-induced arterial compromise.

Conclusions:

• Routine intraoperative angiography is the most cost-effective completion angiography method currently available after cerebral aneurysm clipping.
• The findings support the widespread adoption of routine intraoperative angiography for improved outcomes and efficiency.