A cost-utility analysis comparing endovascular coiling to neurosurgical clipping in the treatment of aneurysmal subarachnoid haemorrhage
Ahmed A, Ahmed Y, Duah-Asante K, Lawal A, Mohiaddin Z, Nawab H, Tang A, Wang B, Miller G, Malawana J
Neurosurgical review. 2022
Endovascular coiling (EC) has been identified in systematic reviews and meta-analyses to produce more favourable clinical outcomes in comparison to neurosurgical clipping (NC) when surgically treating a subarachnoid haemorrhage from a ruptured aneurysm. Cost-effectiveness analyses between both interventions have been done, but no cost-utility analysis has yet been published. This systematic review aims to perform an economic analysis of the relative utility outcomes and costs from both treatments in the UK. A cost-utility analysis was performed from the perspective of the National Health Service (NHS), over a 1-year analytic horizon. Outcomes were obtained from the randomised International Subarachnoid Aneurysm Trial (ISAT) and measured in terms of the patient's modified Rankin scale (mRS) grade, a 6-point disability scale that aims to quantify a patient's functional outcome following a stroke. The mRS score was weighted against the Euro-QoL 5-dimension (EQ-5D), with each state assigned a weighted utility value which was then converted into quality-adjusted life years (QALYs). A sensitivity analysis using different utility dimensions was performed to identify any variation in incremental cost-effectiveness ratio (ICER) if different input variables were used. Costs were measured in pounds sterling (£) and discounted by 3.5% to 2020/2021 prices. The cost-utility analysis showed an ICER of - £144,004 incurred for every QALY gained when EC was utilised over NC. At NICE's upper willingness-to-pay (WTP) threshold of £30,000, EC offered a monetary net benefit (MNB) of £7934.63 and health net benefit (HNB) of 0.264 higher than NC. At NICE's lower WTP threshold of £20,000, EC offered an MNB of £7478.63 and HNB of 0.374 higher than NC. EC was found to be more 'cost-effective' than NC, with an ICER in the bottom right quadrant of the cost-effectiveness plane-indicating that it offers greater benefits at lower costs. This is supported by the ICER being below the NICE's threshold of £20,000-£30,000 per QALY, and both MNB and HNB having positive values (> 0).
Premenstrual syndrome and atopy: a double-blind clinical evaluation of treatment with a gamma-globulin/histamine complex
Atton-Chamla A, Favre G, Goudard JR, Miller G, Rocca Serra JP, Teitelbaum M, Vallette C, Charpin J
The relationship between atopy and premenstrual syndrome was studied in 138 women, aged between 20 and 39-years' old, who had suffered from symptoms for at least 6 months. The results showed that there was a high incidence of a personal or familial history of allergy, immediate positive skin test reactions to conventional allergens, eosinophilia, low titre of histamine latex test and high levels of IgE in the premenstrual syndrome patients compared with the normal controls. A preliminary study in 40 patients showed that a course of treatment using a gamma-globulin/histamine complex by subcutaneous injection produced a satisfactory response in 70%. A follow-on double-blind, placebo-controlled study was carried out using the same drug in 42 out of 86 women. Very effective or effective symptomatic relief was significantly higher in the group receiving active treatment. The best results were obtained in patients who had high IgE levels.