The Cost-Utility of CT Angiography and Conventional Angiography for People Presenting with Intracerebral Hemorrhage

Aviv, Richard I.; Kelly, Adam G.; Jahromi, Babak S.; Benesch, Curtis; Young, Kate

doi:10.1371/journal.pone.0096496

Cited by 7 publications

(2 citation statements)

References 41 publications

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“…According to the data, Markov model inter-state transfer probabilities were calculated. Subsequent costs, the values for patients' re-bleeding rates, subsequent re-bleeding rates, disease-specific mortality and utility values for each health state were derived from previously published studies (13,14). The values for specific parameters are presented in Table 3.…”

Section: Results Of the Health Economics Evaluation Model's Structu...mentioning

confidence: 99%

Long-term outcomes and cost-effectiveness evaluation of robot-assisted stereotactic hematoma drainage for spontaneous intracerebral hemorrhage

Tan,

Peng,

et al. 2023

Front. Neurol.

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BackgroundTo investigate the long-term follow-up and economic estimation outcomes of hematoma drainage for spontaneous intracerebral hemorrhage (SICH) with the assistance of neurosurgical navigation and positioning planning system (referred to as robot).MethodsData were retrospectively obtained from consecutive patients with SICH who were admitted to our single-center between March 2019 and March 2022. Different minimally invasive surgery (MIS) procedures were performed according to the inclusion/exclusion criteria. The different groups were sampled and matched using the propensity score method, with age, sex, history of stroke, hypertension, bleeding volume and site of bleeding as matching variables, and matched with inverse probability weighting using R statistical analysis software. From the time of discharge up until 1 year after the surgery, records were gathered on clinical results and medical expenditures. An analysis was conducted to compare the costs and health outcomes of both robot-assisted stereotactic hematoma drainage and neuro-endoscopic surgery, considering both short-term and long-term effects. Health outputs were measured using modified Rankin scale (mRS) and quality adjusted life years (QALYs).ResultsOf the 142 patients, there were 77 patients in the robotic surgery group and 65 patients in the neuro-endoscopic surgery group. Propensity score sampling was matched, resulting in a balanced and comparable group of 37 patients in each, with the robotic surgery group [mean age (57.29 ± 12.74) years, 27 males (72.97%), hematoma volume (44.54 ± 10.49 ml), 22 deep location (59.46%)] and the neuro-endoscopic surgery group [mean age (57.27 ± 11.12) years, 27 males (72.97%), hematoma volume (44.70 ± 10.86 ml), 23 deep location (62.16%)]. At both three-month and one-year postoperative follow-up, the proportion of mRS scores ≤3 was higher in the robotic surgery group (45.95%,70.27%) than in the neuro-endoscopic surgery group (35.14%, 62.16%), but there was no statistically significant difference (P = 0.344, 0.461). One year after surgery, the robotic group demonstrated cost savings of ¥36,862.14 per individual and a gain of 0.062 QALYs compared to the neuro-endoscopic group.ConclusionOur calculations based on a model for SICH suggest that robotic-assisted stereotactic drainage offers health economic benefits due to its lower cost and higher effectiveness. However, to confirm these findings, more data from multicenter, prospective randomized controlled trials with larger sample sizes are needed.

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Section: Results Of the Health Economics Evaluation Model's Structu...mentioning

confidence: 99%

Long-term outcomes and cost-effectiveness evaluation of robot-assisted stereotactic hematoma drainage for spontaneous intracerebral hemorrhage

Tan,

Peng,

et al. 2023

Front. Neurol.

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“…This group included models that did not fall under the other 3 categories, including Markov models with idiosyncratic approaches to modeling disability and recurrence [22][23][24], an extended decision tree-type model [25], and one model based on differential equations [26]. Table 1 summarizes the extent to which the model designs are applicable or relevant to modeling CI, based on the design section of the ISPOR relevance and credibility questionnaire [11].…”

Section: Group 4: Other (K = 5)mentioning

confidence: 99%

Poststroke Cognitive Impairment in Model-Based Economic Evaluation: A Systematic Review

Sexton

Merriman

Donnelly

et al. 2019

Dement Geriatr Cogn Disord

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Introduction: Cognitive impairment (CI) is a frequent consequence of stroke and is associated with increased costs and reduced quality of life. However, its inclusion in model-based economic evaluation for stroke is limited. Objective: To identify, review, and critically appraise current models of stroke for use in economic evaluation, and to identify applicability to modeling poststroke CI. Methods: PubMed, EMBASE, and the NHS Economic Evaluations Database (NHS EED) were systematically searched for papers published from January 2008 to August 2018. Studies that described the development or design of a model of stroke progression intended for use in economic evaluation were included. Abstracts were screened, followed by full text review of potentially relevant articles. Models that included CI were retained for data extraction, and among the remainder, models that included both stroke recurrence and disability were also retained. Relevance and potential for adaptation for modeling CI were assessed using a standard questionnaire. Results: Forty modeling studies were identified and categorized into 4 groups: Markov disability/recurrence (k = 29); CI (k = 2); discrete event simulation (k = 4), and other (k = 5). Only 2 modeling studies included CI as an outcome, and both focused on narrow populations at risk of intracranial aneurysm. None of the models allowed for disease progression in the absence of a stroke recurrence. None of the included studies carried out any sensitivity analysis in relation to model design or structure. Conclusions: Current stroke models used in economic evaluation are not adequate to model poststroke CI or dementia, and will require adaptation to be used for this purpose.There were substantial commonalities in model design and structure, with 4 groupings identified: Markov disability and recurrence model, Markov cognition model, DES, and other. Group 1: Markov Disability and Recurrence Model (k = 29)This group included cohort level Markov models. These models tracked cohorts of patients through 2 or more disability states, recurrent stroke, and death. Disability states were generally defined using the mRS (27/29 studies) [14]. This model structure did not allow any disease progression (deterioration or improvement) in the absence of stroke recurrence, apart from 2 models which allowed for progression during a short "rehabilitation" phase [15,16].Deterministic and probabilistic sensitivity analyses were used to handle uncertainty in parameter estimates. However, there was limited or no sensitivity analysis in relation to model structure or key underlying assumptions regarding disease progression. Only 3/29 reported validation against observational data [15,17,18]. dementia. We aim to synthesize an approach that models stroke disease progression as an ongoing risk of stroke recurrence, with the CI/dementia approach which models a continuous risk of cognitive decline (see http://www.strokecog.ie/ for more details). ConclusionThere is limited diversity in model design and structure in model-bas...

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The role of computed tomography angiogram in intracranial hemorrhage. Do the benefits justify the known risks in everyday practice?

Alshumrani

nasser

Alzawani

et al. 2021

Clinical Neurology and Neurosurgery

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The Cost-Utility of CT Angiography and Conventional Angiography for People Presenting with Intracerebral Hemorrhage

Cited by 7 publications

References 41 publications

Long-term outcomes and cost-effectiveness evaluation of robot-assisted stereotactic hematoma drainage for spontaneous intracerebral hemorrhage

Long-term outcomes and cost-effectiveness evaluation of robot-assisted stereotactic hematoma drainage for spontaneous intracerebral hemorrhage

Poststroke Cognitive Impairment in Model-Based Economic Evaluation: A Systematic Review

The role of computed tomography angiogram in intracranial hemorrhage. Do the benefits justify the known risks in everyday practice?

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