Biomaterial Database

Cost-effectiveness of angiography performed during surgery for ruptured intracranial aneurysms. 1997

D F Kallmes, and M H Kallmes

Department of Radiology, University of Virginia Health Sciences Center, Charlottesville 22906, USA.

OBJECTIVE To calculate the incremental cost-utility ratio for routine angiography performed during surgery for ruptured cerebral aneurysms. METHODS Decision-tree and Markov analyses based on a cohort simulation were used to determine the incremental cost-utility ratio of routine intraoperative angiography versus no angiography. Input data from the literature were estimated for the following variables: frequency of unexpected aneurysmal rests and branch artery occlusions; annual rate of rehemorrhage of partially clipped aneurysms; prevalence of clinically relevant infarction resulting from branch artery occlusion; efficacy of clip repositioning; morbidity associated with intraoperative angiography; morbidity and mortality associated with aneurysmal rehemorrhage; sensitivity of intraoperative angiography for aneurysmal rests; and costs of intraoperative angiography, added duration of surgery, ischemic cerebral infarction, aneurysmal rehemorrhage, and rehabilitation. Sensitivity analyses were performed for all relevant input variables. A societal perspective was used, and cost-utility ratios less than $50000/quality-adjusted life years (QALY) gained were considered acceptable. RESULTS Baseline input variables resulted in an acceptable cost-utility ratio for routine intraoperative angiography ($19000/QALY). The input variables with greatest influence on the cost-utility ratio were frequency of branch artery occlusions, angiographic morbidity, and cost of angiography. However, the cost-utility ratio remained acceptable even over wide ranges of these input variables. Frequency of unexpected partially clipped aneurysms, efficacy of clip repositioning, and costs of stroke, rehemorrhage, and rehabilitation had relatively little impact on the analysis. CONCLUSIONS Routine intraoperative angiography is cost-effective if performed in a manner consistent with low morbidity in a patient cohort harboring at least some unexpected branch artery occlusions that, if uncorrected, would result in clinically relevant cerebral infarctions.

UI	MeSH Term	Description	Entries
D007431	Intraoperative Complications	Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure.	Peroperative Complications,Surgical Injuries,Complication, Intraoperative,Complication, Peroperative,Injuries, Surgical,Complications, Intraoperative,Complications, Peroperative,Injury, Surgical,Intraoperative Complication,Peroperative Complication,Surgical Injury
D008297	Male		Males
D008390	Markov Chains	A stochastic process such that the conditional probability distribution for a state at any future instant, given the present state, is unaffected by any additional knowledge of the past history of the system.	Markov Process,Markov Chain,Chain, Markov,Chains, Markov,Markov Processes,Process, Markov,Processes, Markov
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D011183	Postoperative Complications	Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.	Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011237	Predictive Value of Tests	In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test.	Negative Predictive Value,Positive Predictive Value,Predictive Value Of Test,Predictive Values Of Tests,Negative Predictive Values,Positive Predictive Values,Predictive Value, Negative,Predictive Value, Positive
D012008	Recurrence	The return of a sign, symptom, or disease after a remission.	Recrudescence,Relapse,Recrudescences,Recurrences,Relapses
D002532	Intracranial Aneurysm	Abnormal outpouching in the wall of intracranial blood vessels. Most common are the saccular (berry) aneurysms located at branch points in CIRCLE OF WILLIS at the base of the brain. Vessel rupture results in SUBARACHNOID HEMORRHAGE or INTRACRANIAL HEMORRHAGES. Giant aneurysms (>2.5 cm in diameter) may compress adjacent structures, including the OCULOMOTOR NERVE. (From Adams et al., Principles of Neurology, 6th ed, p841)	Aneurysm, Cerebral,Aneurysm, Intracranial,Basilar Artery Aneurysm,Berry Aneurysm,Brain Aneurysm,Cerebral Aneurysm,Giant Intracranial Aneurysm,Mycotic Aneurysm, Intracranial,Aneurysm, Anterior Cerebral Artery,Aneurysm, Anterior Communicating Artery,Aneurysm, Basilar Artery,Aneurysm, Middle Cerebral Artery,Aneurysm, Posterior Cerebral Artery,Aneurysm, Posterior Communicating Artery,Anterior Cerebral Artery Aneurysm,Anterior Communicating Artery Aneurysm,Middle Cerebral Artery Aneurysm,Posterior Cerebral Artery Aneurysm,Posterior Communicating Artery Aneurysm,Aneurysm, Berry,Aneurysm, Brain,Aneurysm, Giant Intracranial,Aneurysm, Intracranial Mycotic,Aneurysms, Basilar Artery,Aneurysms, Berry,Aneurysms, Brain,Aneurysms, Cerebral,Aneurysms, Giant Intracranial,Aneurysms, Intracranial,Aneurysms, Intracranial Mycotic,Artery Aneurysm, Basilar,Artery Aneurysms, Basilar,Basilar Artery Aneurysms,Berry Aneurysms,Brain Aneurysms,Cerebral Aneurysms,Giant Intracranial Aneurysms,Intracranial Aneurysm, Giant,Intracranial Aneurysms,Intracranial Aneurysms, Giant,Intracranial Mycotic Aneurysm,Intracranial Mycotic Aneurysms,Mycotic Aneurysms, Intracranial
D002533	Cerebral Angiography	Radiography of the vascular system of the brain after injection of a contrast medium.	Angiography, Cerebral,Angiographies, Cerebral,Cerebral Angiographies
D003198	Computer Simulation	Computer-based representation of physical systems and phenomena such as chemical processes.	Computational Modeling,Computational Modelling,Computer Models,In silico Modeling,In silico Models,In silico Simulation,Models, Computer,Computerized Models,Computer Model,Computer Simulations,Computerized Model,In silico Model,Model, Computer,Model, Computerized,Model, In silico,Modeling, Computational,Modeling, In silico,Modelling, Computational,Simulation, Computer,Simulation, In silico,Simulations, Computer