Abstract
It was hypothesized that the cost-effectiveness of PED differs depending on aneurysm size. We evaluated the cost-effectiveness of PED for the treatment of small, medium, large and giant aneurysms compared to stent-assisted coiling (SAC) and neurosurgical clipping (NC), from a third-party payer perspective in Colombia. A York Health Economics Consortium PED model was adapted to the payer perspective in Colombia, using a time horizon of 5 and 10 years. Analysis were conducted for different aneurysm sizes: Small (<7 mm), Medium (7-12 mm), Large (13-24 mm) and Giant (>24 mm). Inputs were taken from international literature on procedural mortality, retreatment, death following retreatment, the rate of rupture and resource use, and stratified according to aneurysm size when available. Inputs on adverse events was not stratified. Costs came from the official Colombian price list and resource use validated with a KOL. Stratification was possible for a small number of cost variables. The cost-effectiveness threshold for Colombia is $19,494. PED vs SAC : 5 years. PED is a dominant therapy vs SAC in medium, large and giant aneurysms, and is highly cost-effectiveness in small aneurysms. PED vs NC: 5 years. PED is a cost-effectiveness therapy vs NC in large and giant aneurysms, with an ICER of $17,203 and $16,821per QALY gained, respectively. PED has fewer adverse events, lower mortality, and complications. PED vs NC : 10 years. The cost-effectiveness of PED in large and giant aneurysms was $11,512 and $11,093 per QALY gained respectively. Our findings suggest that in Colombia, PED is a cost-effective treatment compared to neurosurgical clipping for patients with large and giant aneurysms. PED is a highly cost-effectiveness treatment compared with stent assisted coiling in patients with small aneurysm, and is dominant in patients with medium, large and giant aneurysms.
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