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Cost effectiveness of screening for intracranial aneurysms among patients with bicuspid aortic valve: a Markov
Jigang Chen1,2, Mingyang Han3, Xin Feng4
1Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Insights
Screening for intracranial aneurysms (IAs) in patients with bicuspid aortic valve (BAV) improves outcomes. A strategy of screening every 10 years with biennial follow-up is the most cost-effective approach.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Health Economics
Background:
- Bicuspid aortic valve (BAV) affects a significant population.
- Patients with BAV have a higher prevalence of intracranial aneurysms (IAs), increasing the risk of subarachnoid hemorrhage (SAH).
Purpose of the Study:
- To evaluate the cost-effectiveness of different screening and follow-up strategies for intracranial aneurysms (IAs) in patients with bicuspid aortic valve (BAV).
Main Methods:
- A decision-analytic model was developed to compare various management strategies.
- Evaluated strategies included natural history, screening with no follow-up, and regular screening with follow-up.
- Cost-effectiveness analysis was performed from a Chinese healthcare payer's perspective, including sensitivity analyses.
Main Results:
- The 'natural history' approach was least costly and effective.
- Screening every 10 years with biennial follow-up (Every 10y/Biennial) was found to be cost-effective compared to other screening intervals.
- Sensitivity analyses confirmed Every 10y/Biennial as the dominant strategy under most conditions.
Conclusions:
- Implementing screening and follow-up for IAs in BAV patients enhances effectiveness.
- The Every 10y/Biennial strategy is optimal for managing IAs in BAV patients from a healthcare payer's viewpoint.
Objective:
Bicuspid aortic valve (BAV) is common and 7.7%-9.8% of patients with BAV have intracranial aneuryms (IAs) which might lead to a devastating subarachnoid haemorrhage (SAH). We aimed to evaluate different screening and follow-up strategies using magnetic resonance angiography for IAs among patients with BAV.
Methods:
A decision-analytic model was built to evaluate the costs and effectiveness of different management strategies from the Chinese healthcare payer's perspective. The evaluated strategies included natural history without screening for possible IAs, regular screening and no follow-up for detected IAs, and regular screening with regular follow-up (Screen strategy/Follow-up strategy). Base case calculation, as well as probabilistic, one-way, and two-way sensitivity analyses, were performed.
Results:
According to the base case calculation, natural history had the least cost and effectiveness while Every 5 years (y)/Annual gained the highest cost and effectiveness. Every 10y/Biennial was cost effective when compared with Every 10y/Every 5y under the willingness-to-pay threshold of ¥211 743 (US$30 162). Probabilistic sensitivity analysis showed that Every 10y/Biennial was superior in 88.3% of the cases when compared with Every 10y/Every 5y. One-way and two-way sensitivity analyses proved that Every 10y/Biennial was the dominant strategy under most circumstances.
Conclusions:
Screening for possible IAs among patients with BAV and follow-up for detected IAs would increase the effectiveness. Every 10y/Biennial was the optimal strategy from the Chinese healthcare payer's perspective.
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