Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?

<h4>Background</h4>Unruptured intracranial aneurysms (UIA) are increasingly being treated by endovascular coiling as opposed to open surgical clipping. Unfortunately, endovascular coiling imparts an approximate 25% recanalization rate, leading to additional procedures and increased ruptu...

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Autores principales:	David Ben-Israel, Brooke L Belanger, Amin Adibi, Muneer Eesa, Alim P Mitha, Eldon Spackman
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0ca0c90400df4ee6bfb52e957fe335df
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spelling	oai:doaj.org-article:0ca0c90400df4ee6bfb52e957fe335df2021-12-02T20:18:30ZInnovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?1932-620310.1371/journal.pone.0255870https://doaj.org/article/0ca0c90400df4ee6bfb52e957fe335df2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255870https://doaj.org/toc/1932-6203<h4>Background</h4>Unruptured intracranial aneurysms (UIA) are increasingly being treated by endovascular coiling as opposed to open surgical clipping. Unfortunately, endovascular coiling imparts an approximate 25% recanalization rate, leading to additional procedures and increased rupture risk. While a new health technology innovation (HTI) that reduces this recanalization rate would benefit patients, few advancements have been made. We aim to determine whether cost-effectiveness has been a barrier to HTI.<h4>Methods</h4>A probabilistic Markov model was constructed from the healthcare payer perspective to compare standard endovascular treatment of UIA to standard treatment plus the addition of a HTI adjunct. Costs were measured in 2018 USD and health outcomes were measured in quality-adjusted life-years (QALY). In the base case, the HTI was a theoretical mesenchymal stem cell therapy which reduced the aneurysm recanalization rate by 50% and cost $10,000 per procedure. All other model inputs were derived from the published scientific literature.<h4>Results</h4>Based on the model results, we found that for a given HTI price (y) and relative risk reduction of aneurysm recanalization (x), the HTI was always cost-effective if the following equation was satisfied: y ≤ 20268 ∙ x, using a willingness-to-pay threshold of $50,000 per QALY. The uncertainty surrounding whether an aneurysm would recanalize was a significant driver within the model. When the uncertainty around the risk of aneurysm recanalization was eliminated, the 10-year projected additional benefit to the United States healthcare system was calculated to be $113,336,994.<h4>Conclusion</h4>Cost-effectiveness does not appear to be a barrier to innovation in reducing the recanalization rate of UIA treated by endovascular coil embolization. Our model can now be utilized by academia and industry to accentuate economically feasible HTI and by healthcare payers to calculate their maximum willingness-to-pay for a new technology. Our results also indicate that predicting a patient's baseline risk of aneurysm recanalization is a critical area of future research.David Ben-IsraelBrooke L BelangerAmin AdibiMuneer EesaAlim P MithaEldon SpackmanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255870 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q David Ben-Israel Brooke L Belanger Amin Adibi Muneer Eesa Alim P Mitha Eldon Spackman Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?
description	<h4>Background</h4>Unruptured intracranial aneurysms (UIA) are increasingly being treated by endovascular coiling as opposed to open surgical clipping. Unfortunately, endovascular coiling imparts an approximate 25% recanalization rate, leading to additional procedures and increased rupture risk. While a new health technology innovation (HTI) that reduces this recanalization rate would benefit patients, few advancements have been made. We aim to determine whether cost-effectiveness has been a barrier to HTI.<h4>Methods</h4>A probabilistic Markov model was constructed from the healthcare payer perspective to compare standard endovascular treatment of UIA to standard treatment plus the addition of a HTI adjunct. Costs were measured in 2018 USD and health outcomes were measured in quality-adjusted life-years (QALY). In the base case, the HTI was a theoretical mesenchymal stem cell therapy which reduced the aneurysm recanalization rate by 50% and cost $10,000 per procedure. All other model inputs were derived from the published scientific literature.<h4>Results</h4>Based on the model results, we found that for a given HTI price (y) and relative risk reduction of aneurysm recanalization (x), the HTI was always cost-effective if the following equation was satisfied: y ≤ 20268 ∙ x, using a willingness-to-pay threshold of $50,000 per QALY. The uncertainty surrounding whether an aneurysm would recanalize was a significant driver within the model. When the uncertainty around the risk of aneurysm recanalization was eliminated, the 10-year projected additional benefit to the United States healthcare system was calculated to be $113,336,994.<h4>Conclusion</h4>Cost-effectiveness does not appear to be a barrier to innovation in reducing the recanalization rate of UIA treated by endovascular coil embolization. Our model can now be utilized by academia and industry to accentuate economically feasible HTI and by healthcare payers to calculate their maximum willingness-to-pay for a new technology. Our results also indicate that predicting a patient's baseline risk of aneurysm recanalization is a critical area of future research.
format	article
author	David Ben-Israel Brooke L Belanger Amin Adibi Muneer Eesa Alim P Mitha Eldon Spackman
author_facet	David Ben-Israel Brooke L Belanger Amin Adibi Muneer Eesa Alim P Mitha Eldon Spackman
author_sort	David Ben-Israel
title	Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?
title_short	Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?
title_full	Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?
title_fullStr	Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?
title_full_unstemmed	Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?
title_sort	innovation in unruptured intracranial aneurysm coiling: at which price or efficacy are new technologies cost-effective?
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/0ca0c90400df4ee6bfb52e957fe335df
work_keys_str_mv	AT davidbenisrael innovationinunrupturedintracranialaneurysmcoilingatwhichpriceorefficacyarenewtechnologiescosteffective AT brookelbelanger innovationinunrupturedintracranialaneurysmcoilingatwhichpriceorefficacyarenewtechnologiescosteffective AT aminadibi innovationinunrupturedintracranialaneurysmcoilingatwhichpriceorefficacyarenewtechnologiescosteffective AT muneereesa innovationinunrupturedintracranialaneurysmcoilingatwhichpriceorefficacyarenewtechnologiescosteffective AT alimpmitha innovationinunrupturedintracranialaneurysmcoilingatwhichpriceorefficacyarenewtechnologiescosteffective AT eldonspackman innovationinunrupturedintracranialaneurysmcoilingatwhichpriceorefficacyarenewtechnologiescosteffective
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Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?

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