A mathematical model of utility for single screening of asymptomatic unruptured intracranial aneurysms at the age of 50 years

Acta neurochirurgica
Lucia M LiRamez W Kirollos

Abstract

Although rupture of intracranial aneurysms carries high mortality and morbidity rates, the clinical and financial benefit of screening certain high-risk groups is uncertain. We designed a mathematical model to interrogate the clinical benefit and cost-effectiveness of screening. A decision tree analysis model was used to calculate the outcome and cost of two scenarios applied to the same population: one-off screening for intracranial aneurysms versus not screening. Each scenario had an associated gain or loss of Quality Adjusted Life Years (QALY) and cost; the difference between the two scenarios was calculated. The variable inputs were the aneurysm prevalence and risk of rupture after 5 years. Sensitivity analyses were performed to determine the effects of altering various factors on outcomes. Screening of the asymptomatic general population results in a QALY loss, equating to a negative clinical impact. The threshold 5-year risk of rupture at which screening resulted in a gain in QALYs was 13 %. This held true for any prevalence between 1 and 25 %. Risk of rupture had a greater impact on outcome than prevalence. Halving the risk of intervention (either surgery or coiling) reduced the threshold 5-year risk of rupture at which ...Continue Reading

References

Apr 1, 1994·Kidney International·D ChauveauJ P Grünfeld
Aug 1, 1997·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·R Leblanc
Aug 6, 1999·Stroke; a Journal of Cerebral Circulation·Y Yoshimoto, S Wakai
Jan 29, 2000·Brain : a Journal of Neurology·J M Wardlaw, P M White
Aug 21, 2001·Journal of Neurology, Neurosurgery, and Psychiatry·P M WhiteV Easton
Apr 5, 2003·Kidney International·Mark M BelzPatricia A Gabow
Jul 18, 2003·Lancet·David O WiebersUNKNOWN International Study of Unruptured Intracranial Aneurysms Investigators
Jan 18, 2005·Journal of Neurology, Neurosurgery, and Psychiatry·R R VindlacheruvuP Mitchell
Jan 30, 2007·Lancet·Jan van GijnGabriel J E Rinkel
Apr 20, 2007·The Cochrane Database of Systematic Reviews·P A Cosford, G C Leng
Feb 27, 2008·Neurology·A Stijntje E BorGabriel J E Rinkel
Mar 8, 2008·Stroke; a Journal of Cerebral Circulation·Tatiana ForoudUNKNOWN FIA Study Investigators
Apr 19, 2008·Neurology·Marieke J H WermerUNKNOWN ASTRA Study Group
Oct 16, 2008·Health Economics·Helen MasonCam Donaldson
Nov 22, 2008·Stroke; a Journal of Cerebral Circulation·Joseph D BurnsRobert D Brown
Dec 20, 2008·Journal of Korean Neurosurgical Society·Jin Soo LeeSoo Hyun Hwang
Jan 16, 2009·BMC Medical Genetics·Tatiana ForoudUNKNOWN Familial Intracranial Aneurysm Study Investigators
Jan 28, 2009·BMJ : British Medical Journal·Adrian Towse
Mar 2, 2010·Stroke; a Journal of Cerebral Circulation·Ranjan DekaUNKNOWN FIA Study Investigators
Apr 10, 2010·Stroke; a Journal of Cerebral Circulation·Maryam RahmanJ Mocco
Dec 18, 2010·Stroke; a Journal of Cerebral Circulation·H W XuMing Hua Li
May 10, 2011·Clinical Journal of the American Society of Nephrology : CJASN·Maria V IrazabalVicente E Torres

❮ Previous
Next ❯

Citations

Jun 18, 2014·Nature Reviews. Nephrology·Nada KanaanYves Pirson
Jun 1, 2018·Vascular Medicine·Gabor Toth, Russell Cerejo
Nov 6, 2018·Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine·Chun-Wei ChangTony Wu
Jun 4, 2020·Asian Cardiovascular & Thoracic Annals·Saad Moughal, Mohamad Bashir

❮ Previous
Next ❯

Related Concepts

Related Feeds

Aneurysm

Aneurysms are outward distensions or bulges that occurs in a weakened wall of blood vessels. Discover the latest research on aneurysms here.