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Treatment of Unruptured Intracranial Aneurysms: Decision and Cost-effectiveness Analysis¹

¹ From the Department of Radiology, Showa General Hospital, Tokyo, Japan (H.T.); Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan (H.T.); and Department of General Medicine and Clinical Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan (T.N.). Received July 23, 2006; revision requested October 2; revision received October 18; accepted November 21; final version accepted January 8, 2007. Address correspondence to H.T. (e-mail: takaoh-tky{at}umin.ac.jp).

Purpose: To prospectively perform a decision and cost-effectiveness analysis of surgical and endovascular treatments of unruptured intracranial aneurysms, with incorporation of the results of the prospective International Study of Unruptured Intracranial Aneurysms.

Materials and Methods: With use of a Markov model, a decision and cost-effectiveness analysis was performed for comparison of surgical or endovascular treatment with no treatment. Twelve clinical scenarios were defined on the basis of aneurysm size and location. Probabilistic sensitivity analyses were performed for 50- and 40-year-old patient cohorts. Treatment was considered to be cost-effective at an incremental cost-effectiveness ratio less than $100 000 per quality-adjusted life-year.

Results: In 50-year-old patients, no treatment was the most cost-effective strategy for aneurysms located in the cavernous carotid artery. For aneurysms smaller than 7 mm located in the anterior circulation, no treatment was the most cost-effective strategy. Endovascular treatment was the most cost-effective option for 7–24-mm aneurysms, whereas surgical treatment was the most cost-effective option for aneurysms 25 mm or larger. For aneurysms smaller than 7 mm or 25 mm or larger located in the posterior circulation, no treatment was the most cost-effective strategy. Surgical treatment was the most cost-effective option for 7–12-mm aneurysms, whereas endovascular treatment was the most cost-effective option for 13–24-mm aneurysms.

Conclusion: For 50-year-old patients, treatment of aneurysms that are small (<7 mm), that are located in the cavernous carotid artery, or that are large (25 mm) and located in the posterior circulation is ineffective or not cost-effective.

© RSNA, 2007

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