‘Cost’ NOT RECOVERY! You’re fired along with your mentors and senior researchers!
Cost-Effectiveness Analysis of Early Minimally Invasive Removal of Intracerebral Hemorrhage
Abstract
BACKGROUND:
Supratentorial
intracerebral hemorrhage (ICH) is common and often devastating. In a
randomized controlled trial, ICH evacuation with minimally invasive
trans-sulcal parafascicular surgery (MIPS) improved functional outcomes
at 180 days compared with medical management (MM), primarily in patients
with lobar hemorrhages. The cost-effectiveness of MIPS compared with MM
is explored.
METHODS:
A
Markov model compared costs and outcomes using ENRICH trial (Early
Minimally Invasive Removal of Intracerebral Hemorrhage) data for MIPS
versus MM over the 6-month trial duration. Costs were $2020 and
effectiveness was quality-adjusted life years. Monthly model transitions
between modified Rankin Scale score health states were estimated from
trial data. Costs were obtained from US databases and literature. MIPS
device costs were $5705/patient. Primary outcomes were total hospital
costs from the hospital perspective and the incremental
cost-effectiveness ratio between MIPS and MM (ie, the 6-month cost
difference between strategies divided by quality-adjusted life year
difference) for the healthcare perspective for patients with lobar ICH.
Sensitivity analyses were performed.
RESULTS:
From
the hospital perspective, MIPS costs were $2782 less per patient than
MM ($74 252 versus $77 034), with MIPS having decreased the intensive
care unit hospital length of stay, non-MIPS neurosurgery, mortality, and
rehospitalization. From the healthcare perspective, including hospital
and nonhospital costs, MIPS in lobar ICH cost $8850 less and gained
0.068 quality-adjusted life year per patient compared with MM; thus MIPS
was dominant (less costly and more effective). Results were robust to
individual parameter variation over plausible ranges and, with all
parameters varied simultaneously in a probabilistic sensitivity
analysis, MIPS was dominant in >93% of 10 000 model iterations and
favored in >99% at $100 000/quality-adjusted life year gained (a
common US benchmark).
CONCLUSIONS:
In
the ENRICH randomized controlled trial, MIPS cost less and was more
effective compared with MM from both hospital and healthcare
perspectives for patients with lobar ICH.
REGISTRATION:
Unique identifier: NCT02880878.
Graphical Abstract
