Cost-Effectiveness Analysis Applied to the Treatment of Unruptured Anterior Circulation Aneurysms in a Middle-Income Country

Objective: Controversy exists regarding the best treatment option for unruptured anterior circulation aneurysms (UA); thus, we performed a long-term cost-effectiveness analysis comparing different treatment options from an economic standpoint. Methods: A decision-tree model was built based on a hypothetical cohort of 1,000 patients undergoing treatment for UA. Health outcomes and cost analysis were modeled over the projected lifetime. All treatment outcome probabilities and likelihood ratios were obtained from major natural history and outcome studies. Costs were assessed from the societal perspective of the general healthcare system in Colombia. A univariate sensitivity analysis was conducted to evaluate the impact and significance of the results. Results: Significant differences were shown in treatment cost and total effectiveness. SC had a mean treatment cost of US$2,322 and a cost-effectiveness ratio of US $2,735 (EC: US$4,650 and US$5,798). A univariate sensitivity analysis showed that the total cost-effectiveness of SC remained dominantly superior to EC. Conclusions: From an economic standpoint, results show that SC is the most cost-effective treatment alternative in a middle-income country. These results must be taken into account during the decision-making process for the treatment of intracranial aneurysms, especially in those countries where cost-effective measures are of vital importance. Nevertheless, further studies are warranted in different healthcare-system settings.