Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral Hemorrhage
BackgroundIn patients with spontaneous supratentorial intracerebral hemorrhage (ICH), open craniotomy has failed to improve a functional outcome. Innovative minimally invasive neurosurgery (MIS) may improve a health outcome and reduce healthcare costs.AimsBefore starting phase-III trials, we aim to...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.830614/full |
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| author | Floris H. B. M. Schreuder Mirre Scholte Marike J. Ulehake Lotte Sondag Maroeska M. Rovers Maroeska M. Rovers Ruben Dammers Catharina J. M. Klijn Janneke P. C. Grutters Janneke P. C. Grutters |
| author_facet | Floris H. B. M. Schreuder Mirre Scholte Marike J. Ulehake Lotte Sondag Maroeska M. Rovers Maroeska M. Rovers Ruben Dammers Catharina J. M. Klijn Janneke P. C. Grutters Janneke P. C. Grutters |
| author_sort | Floris H. B. M. Schreuder |
| collection | DOAJ |
| description | BackgroundIn patients with spontaneous supratentorial intracerebral hemorrhage (ICH), open craniotomy has failed to improve a functional outcome. Innovative minimally invasive neurosurgery (MIS) may improve a health outcome and reduce healthcare costs.AimsBefore starting phase-III trials, we aim to assess conditions that need to be met to reach the potential cost-effectiveness of MIS compared to usual care in patients with spontaneous supratentorial ICH.MethodsWe used a state-transition model to determine at what effectiveness and cost MIS would become cost-effective compared to usual care in terms of quality-adjusted life-years (QALYs) and direct healthcare costs. Threshold and two-way sensitivity analyses were used to determine the minimal effectiveness and maximal costs of MIS, and the most cost-effective strategy for each combination of cost and effectiveness. Scenario and probabilistic sensitivity analyses addressed model uncertainty.ResultsGiven €10,000 of surgical costs, MIS would become cost-effective when at least 0.7–1.3% of patients improve to a modified Rankin Scale (mRS) score of 0–3 compared to usual care. When 11% of patients improve to mRS 0–3, surgical costs may be up to €83,301–€164,382, depending on the population studied. The cost-effectiveness of MIS was mainly determined by its effectiveness. In lower mRS states, MIS needs to be more effective to be cost-effective compared to higher mRS states.ConclusionMIS has the potential to be cost-effective in patients with spontaneous supratentorial ICH, even with relatively low effectiveness. These results support phase-III trials to investigate the effectiveness of MIS. |
| first_indexed | 2024-04-12T10:45:05Z |
| format | Article |
| id | doaj.art-aed2c51591a24a02bd9fcf7d8a12278d |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-12T10:45:05Z |
| publishDate | 2022-06-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-aed2c51591a24a02bd9fcf7d8a12278d2022-12-22T03:36:29ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-06-011310.3389/fneur.2022.830614830614Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral HemorrhageFloris H. B. M. Schreuder0Mirre Scholte1Marike J. Ulehake2Lotte Sondag3Maroeska M. Rovers4Maroeska M. Rovers5Ruben Dammers6Catharina J. M. Klijn7Janneke P. C. Grutters8Janneke P. C. Grutters9Department of Neurology, Center for Neuroscience, Donders Institute of Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, NetherlandsDepartment for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Neurology, Center for Neuroscience, Donders Institute of Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, NetherlandsDepartment for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, NetherlandsDepartment of Neurology, Center for Neuroscience, Donders Institute of Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, NetherlandsDepartment for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, NetherlandsBackgroundIn patients with spontaneous supratentorial intracerebral hemorrhage (ICH), open craniotomy has failed to improve a functional outcome. Innovative minimally invasive neurosurgery (MIS) may improve a health outcome and reduce healthcare costs.AimsBefore starting phase-III trials, we aim to assess conditions that need to be met to reach the potential cost-effectiveness of MIS compared to usual care in patients with spontaneous supratentorial ICH.MethodsWe used a state-transition model to determine at what effectiveness and cost MIS would become cost-effective compared to usual care in terms of quality-adjusted life-years (QALYs) and direct healthcare costs. Threshold and two-way sensitivity analyses were used to determine the minimal effectiveness and maximal costs of MIS, and the most cost-effective strategy for each combination of cost and effectiveness. Scenario and probabilistic sensitivity analyses addressed model uncertainty.ResultsGiven €10,000 of surgical costs, MIS would become cost-effective when at least 0.7–1.3% of patients improve to a modified Rankin Scale (mRS) score of 0–3 compared to usual care. When 11% of patients improve to mRS 0–3, surgical costs may be up to €83,301–€164,382, depending on the population studied. The cost-effectiveness of MIS was mainly determined by its effectiveness. In lower mRS states, MIS needs to be more effective to be cost-effective compared to higher mRS states.ConclusionMIS has the potential to be cost-effective in patients with spontaneous supratentorial ICH, even with relatively low effectiveness. These results support phase-III trials to investigate the effectiveness of MIS.https://www.frontiersin.org/articles/10.3389/fneur.2022.830614/fullintracerebral hemorrhage (ICH)health technology assessment (HTA)cost-effectiveness analysisneurosurgeryminimally invasive surgery (MIS) |
| spellingShingle | Floris H. B. M. Schreuder Mirre Scholte Marike J. Ulehake Lotte Sondag Maroeska M. Rovers Maroeska M. Rovers Ruben Dammers Catharina J. M. Klijn Janneke P. C. Grutters Janneke P. C. Grutters Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral Hemorrhage Frontiers in Neurology intracerebral hemorrhage (ICH) health technology assessment (HTA) cost-effectiveness analysis neurosurgery minimally invasive surgery (MIS) |
| title | Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral Hemorrhage |
| title_full | Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral Hemorrhage |
| title_fullStr | Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral Hemorrhage |
| title_full_unstemmed | Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral Hemorrhage |
| title_short | Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral Hemorrhage |
| title_sort | identifying the conditions for cost effective minimally invasive neurosurgery in spontaneous supratentorial intracerebral hemorrhage |
| topic | intracerebral hemorrhage (ICH) health technology assessment (HTA) cost-effectiveness analysis neurosurgery minimally invasive surgery (MIS) |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.830614/full |
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