Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral Hemorrhage

Floris H B M Schreuder; Mirre Scholte; Marike J Ulehake; Lotte Sondag; Maroeska M Rovers; Ruben Dammers; Catharina J M Klijn; Janneke P C Grutters

doi:10.3389/fneur.2022.830614

Identifying the Conditions for Cost-Effective Minimally Invasive Neurosurgery in Spontaneous Supratentorial Intracerebral Hemorrhage

Front Neurol. 2022 Jun 2:13:830614. doi: 10.3389/fneur.2022.830614. eCollection 2022.

Authors

Floris H B M Schreuder¹, Mirre Scholte², Marike J Ulehake³, Lotte Sondag¹, Maroeska M Rovers^{2

3}, Ruben Dammers⁴, Catharina J M Klijn¹, Janneke P C Grutters^{2

3}

Affiliations

¹ Department of Neurology, Center for Neuroscience, Donders Institute of Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands.
² Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
³ Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
⁴ Department of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, Netherlands.

Abstract

Background: In patients with spontaneous supratentorial intracerebral hemorrhage (ICH), open craniotomy has failed to improve a functional outcome. Innovative minimally invasive neurosurgery (MIS) may improve a health outcome and reduce healthcare costs.

Aims: Before starting phase-III trials, we aim to assess conditions that need to be met to reach the potential cost-effectiveness of MIS compared to usual care in patients with spontaneous supratentorial ICH.

Methods: We used a state-transition model to determine at what effectiveness and cost MIS would become cost-effective compared to usual care in terms of quality-adjusted life-years (QALYs) and direct healthcare costs. Threshold and two-way sensitivity analyses were used to determine the minimal effectiveness and maximal costs of MIS, and the most cost-effective strategy for each combination of cost and effectiveness. Scenario and probabilistic sensitivity analyses addressed model uncertainty.

Results: Given €10,000 of surgical costs, MIS would become cost-effective when at least 0.7-1.3% of patients improve to a modified Rankin Scale (mRS) score of 0-3 compared to usual care. When 11% of patients improve to mRS 0-3, surgical costs may be up to €83,301-€164,382, depending on the population studied. The cost-effectiveness of MIS was mainly determined by its effectiveness. In lower mRS states, MIS needs to be more effective to be cost-effective compared to higher mRS states.

Conclusion: MIS has the potential to be cost-effective in patients with spontaneous supratentorial ICH, even with relatively low effectiveness. These results support phase-III trials to investigate the effectiveness of MIS.

Keywords: cost-effectiveness analysis; health technology assessment (HTA); intracerebral hemorrhage (ICH); minimally invasive surgery (MIS); neurosurgery.