Publicado dic 16, 2019



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Pablo Harker

Hoover Quitian-Reyes

Oscar Hernando Feo-Lee

Nicolas Iragorri

Juan Carlos Puentes

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Resumen

Introducción. Existe controversia alrededor del major tratamiento de UA. Por tanto, realizamos un análisis de costo-efectividad comparando las alternativas de tratamiento desde un punto de vista económico.


Métodos. Se construyó un modelo de árbol de decisions basado en una cohort hipotética. Los desenlaces y análisis de costo se modelaron con horizonte temporal de fin de vida. Todas las probabilidades de desenlace se obtuvieron de grandes estudios previamente publicados. Los costos se evaluaron desde la perspectiva del SGSSS en Colombia. Se realize un análisis univariado para evaluar el impacto de los resultados.


Resultados. Se encontraron diferencias significativas en el costo del tratamiento y la efectividad total. El clipaje tuvo un costo promedio de US$2,322 y una relación de costo-efectividad de US$2,735 (US$4,650 y US$5,798 para EC). El análisis univariado mostró que la costo-efectividad del clipaje fue dominantemente superior.


Conclusiones. Desde un punto de vista económico, el clipaje es la alternativa más costo-efectiva en una economía de ingreso medio. Estos resultados deben ser tenidos en cuenta en el proceso de decision, especialmente en países donde las medidas de costo-efectividad son críticas. Sin embargo, se requieren estudios adicionales en diferentes sistemas de salud a nivel mundial.

Keywords
References
1. Longstreth W, Koepsell T, Yerby M, van Belle G. Risk factors for subarachnoid hemorrhage. Stroke. May-Jun 1985;16(3)(377-385).
2. Symonds C. Spontaneous Subarachnoid Haemorrhage. Quarterly Journal of Medicine. 1924;18 (69)(93-122).
3. Dandy W. Intracranial aneurysm of the internal carotid artery: cured by operation. Ann Surg. 1938;107(654-659).
4. Romodanov A, Shcheglov V. Intravascular occlusion of saccular aneurysms of the cerebral arteries by means of a detachable balloon catheter. Advances and Technical Standards in Neurosurgery. 1982;9(25-48).
5. Hilal S, Khandji A, solomon R. Obliteration of intracranial aneurysms with pre-shaped highly thrombogenic coils.. Radiology. 1989;173(250-257).
6. Guglielmi G, Guerrisi R, Guidetti B. [Intravascular Electrothrombosis in Experimentally Induced Vascular Malformations]. Paper presented at: Proceedings of III Congress of the Italian Society of Neuroradiology Bari, Associazione Italiana di Neuroradiologia, 1983; Bari.
7. Guglielmi G, Viñuela F, Duckwiler G, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils.. J Neurosurg. 1992;77(512-524).
8. Guglielmi G, Viñuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. Special article. J Neurosurg. 1991;75(1-7).
9. Strother C. Historical perspective. Electrothrombosis of saccular aneurysms via endovascular approach: part 1 and part 2. Am J Neuroradiol. May 2001;22(5)(1010-1012).
10. Kim M, Park J, Lee J. Comparative Cost Analysis for Surgical and Endovascular Treatment of Unruptured Intracranial Aneurysms in South Korea. J Korean Neurosurg Soc. Jun 2015;57(455-459).
11. Komotar R, Starke R, Connolly E. The natural course of unruptured cerebral aneurysms. Neurosurgery. Oct 2012;71(4)(N7-9).
12. Smith T, Cote D, Dasenbrock H, et al. Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg. Oct 2015;84(4)(942-953).
13. Zhu Y, Pan J, Shen L, et al. Clinical and radiological outcome after treatment of unruptured paraophthalmic internal carotid artery aneurysms: A comparative and pooled analysis of single-center experiences. World Neurosurg. jul 2015;22.
14. Molyneux R, Kerr R, Sneade M, Rischmiller J, Gray R, Group ISAT(C. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360(1267-74).
15. Mitchell P, Kerr R, Mendelow A,MA. Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in ISAT? J Neurosurg. 2008;108(437-442).
16. Conolly EJ. International study of unruptured intracranial aneurysms. Response. J Neurosurg. Nov 2014;121(5)(1022-1023).
17. Mocco J, Nelson-Hopkins L. International Subarachnoid Aneurysm Trial analysis. J Neurosurg. 2008;108(436).
18. Etminan N, Brown R, Beseoglu K, et al. The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus. Neurology. Sept 2015;85(10)(881-889).
19. Johnston S, Gress D, Kahn J. Which unruptured cerebral aneurysms should be treated? A cost-utility analysis. Neurology. Jun 10 1999;59 (2) (1806-1815).
20. Spetzler R, McDougall C, Zabramski J, et al. The Barrow Ruptured Aneurysm Trial: 6-year results. J Neurosurg. Jun 2015;Epub Ahead of Print.
21. Ramachandran M, retarekar R, Raghavan M, et al. Asessment of Image-Derived Risk Factors for Natural Course of Unruptured Cerebral Aneurysms. J Neurosurg. 2016.
22. Connolly Jr E, Rabinstein A, J. Ricardo Carhuapoma MF, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
23. Newman W, Neal D, Hoh B. A new comorbidities index for risk stratification for treatment of unruptured cerebral aneurysms. J Neurosurg. Jan 2016;8(1-7).
24. Takao H, Nojo T. Treatment of Unruptured Intracranial Aneurysms: Decision and Cost-effectiveness Analysis. Radiology. Sept. 2007;244(3).
25. Kuntz K, Sainfort F, M. B, al. e. Decision and Simulation Modeling Alongside Systematic Review. Agency for Healthcare Research and Quality (US). Feb 2013.
26. Wiebers D, Whisnant J, Huston J, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancer. 2003;362(103-110).
27. Bonita R, Beaglehole R. Modification of Rankin Scale: recovery of motor function after stroke. Stroke. 1988;19 (12)(1497-1500).
28. Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957;5(200-215).
29. Duncan P, Zorowitz R, Bates B, et al. AHA/ASA-Endorsed Practice Guidelines. Management of Adult Stroke Rehabilitation Care A Clinical Practice Guideline. Stroke. 36 2005(e100-e143).
30. NICE. Stroke Rehabilitation in Adults. National Clinical Guideline Center - Royal College of Physicians. Jun 12 2013;www.nice.org.uk/guidance/cg162.
31. Lall R, Eddleman C, Bendok B, Batjer H. Unruptured Intracranial Aneurysms and the Assessment of Rupture Risk Based on Anatomical and Morphological Factors: Sifting Through the Sands of Data. Neurosurg Focus. 26 2009;5(E2).
32. Lanzino G, Murad M, d´Urso P, Rabinstein A. Coil embolization versus clipping for ruptured intracranial aneurysms: a meta-analysis of prospective controlled published studies. AJNR Am J Neuroradiol.. Sep 2013;34(9)(1764-1768).
33. Nakagawa T, Hashi K, Kurokawa Y, Yamamura A. Family history of subarachnoid hemorrhage and the incidence of asymptomatic, unruptured cerebral aneurysms. J Neurosurg. Sept 1999;91(3)(391-395).
34. Hoh B, Chi Y, Dermott M, Lipori P, SB. L. The effect of coiling versus clipping of ruptured and unruptured cerebral aneurysms on length of stay, hospital cost, hospital reimbursement, and surgeon reimbursement at the university of Florida. Neurosurgery. Apr 2009;64(4)(614-619).
35. Gonda D, Khalessi A, McCutcheon B, et al. Long-term follow-up of unruptured intracranial aneurysms repaired in California. J Neurosurg. Jun 2014;120(6)(1349-1357).
36. Harbaugh R. Unruptured Intracranial Aneurysms. Who and How to treat? Paper presented at: Simposio FLANC, 2015; Bogotá, Colombia.
37. Johnston S, Gress D, Kahn J. Which unruptured cerebral aneurysms should be treated? a cost-utility analysis. Neurology. 1999;52(1806-1815).
Cómo citar
Harker, P., Quitian-Reyes, H., Feo-Lee, O. H., Iragorri, N., & Puentes, J. C. (2019). Análisis de costo-efectividad en el tratamiento de aneurismas de circulación cerebral anterior en una economía de ingreso medio. Universitas Medica, 61(1). https://doi.org/10.11144/Javeriana.umed61-1.cost
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