Introduction Information on the cost-effectiveness of a new treatment is relevant to decision makers and healthcare providers.
Aim of Study The study compares the cost-effectiveness of the novel Woven Endobridge (WEB) with conventional coiling and stent-assisted coiling (SAC) for intracranial aneurysm treatment, from the perspective of the German Statutory Health Insurance.
Methods A patient-level simulation simulated 55-year-old patients with unruptured middle cerebral artery aneurysms (3–11 mm). The outcomes of WEB treatment, coiling, and SAC were assessed in terms of morbidity, angiographic outcomes, retreatment rates, procedural and rehabilitation costs, and rupture rates. Incremental cost-effectiveness ratios (ICERs) were calculated for cost per quality-adjusted life year (QALY) and cost per year of neurological morbidity avoided. Uncertainty was explored using deterministic and probabilistic sensitivity analyses. Most of the data used were from prospective multicentre trials and meta-analyses of non-randomised trials.
Results In the base case, lifetime QALYs were 13.24 for WEB, 12.92 for SAC, and 12.68 for coiling. Lifetime costs were €20,440 for WEB, €23,167 for SAC, and €8,200 for coiling. Compared to coiling, WEB had an ICER of 21,826 €/QALY, while SAC was dominated by WEB. Probabilistic sensitivity analysis indicated WEB as the preferred treatment at a willingness-to-pay threshold of ≥30,000€/QALY. Deterministic sampling highlighted the discount rate, material costs and retreatment rates as having the greatest impact on ICERs.
Conclusion WEB treatment showed comparable or superior cost-effectiveness to SAC for wide-necked unruptured aneurysms, while coiling was the least expensive option but often inappropriate for wide-necked aneurysms.
Disclosure of Interest CK serves as consultant for Acandis GmbH (Pforzheim, Germany). CK and TL serve as proctors for MicroVention Inc./Sequent Medical (Aliso Viejo, CA, USA). The other authors declare that they have no competing interests.
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