Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?
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 tec...
Gespeichert in:
| Veröffentlicht in: | PloS one 2021-08, Vol.16 (8), p.e0255870 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | 8 |
| container_start_page | e0255870 |
| container_title | PloS one |
| container_volume | 16 |
| creator | Ben-Israel, David Belanger, Brooke L Adibi, Amin Eesa, Muneer Mitha, Alim P Spackman, Eldon |
| description | 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.
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.
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.
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. |
| doi_str_mv | 10.1371/journal.pone.0255870 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_2559639972</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A671258315</galeid><doaj_id>oai_doaj_org_article_0ca0c90400df4ee6bfb52e957fe335df</doaj_id><sourcerecordid>A671258315</sourcerecordid><originalsourceid>FETCH-LOGICAL-c653t-e0ab2470ec1f4a6e9301ab089c83575c0a4aed447905bfb635185eeee6de6c473</originalsourceid><addsrcrecordid>eNqNkluP0zAQhSMEYpeFf4DAEhKChxYnju2EB1C14lJppZW4vVquM0m8cu1iOy399zg0u2oRD-Qlt2_O-JyZLHua43lOeP7mxg3eSjPfOAtzXFBacXwvO89rUsxYgcn9o-ez7FEINxhTUjH2MDsjJeGYc36e7ZbWuq2M2lmkLRqsHzZx8NCkt-il8tJqaZC0MPh9WCPltNG2e4sWEe16rXq08VoBch5B22ol1R5JD8jCDkVQvXXGdRpCKgxxlhBQUW_h_ePsQStNgCfT_SL7_vHDt8vPs6vrT8vLxdVMMUpSAZarouQYVN6WkkFNcC5XuKpVRSinCstSQlOWvMZ01a4YoXlFIV2sAaZKTi6y5wfdjXFBTJkFkeKqGalrXiRieSAaJ29EcrOWfi-c1OLPB-c7IX3UyoDASmJV4xLjpi1Tj9SRFlBT3gIhtGmT1rup27BaQ6NgzNCciJ7-sboXnduK5Cavq_EwryYB734OEKJY66DAmDQAN4znZmmKdVmNzl78hf7b3UR1MhnQtnXjVEdRsWA8L2hFcpqo1yeUcjbCr9jJIQSx_Prl_9nrH6fsyyO2B2liH5wZxnULp2B5AJV3IXho7zLLsRjX_dacGNddTOueyp4d531XdLvf5DfE8P1Q</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2559639972</pqid></control><display><type>article</type><title>Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><source>Public Library of Science (PLoS)</source><creator>Ben-Israel, David ; Belanger, Brooke L ; Adibi, Amin ; Eesa, Muneer ; Mitha, Alim P ; Spackman, Eldon</creator><creatorcontrib>Ben-Israel, David ; Belanger, Brooke L ; Adibi, Amin ; Eesa, Muneer ; Mitha, Alim P ; Spackman, Eldon</creatorcontrib><description>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.
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.
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.
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0255870</identifier><identifier>PMID: 34370777</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aneurysm ; Aneurysms ; Biology and Life Sciences ; Cardiovascular system ; Care and treatment ; Cell therapy ; Complications and side effects ; Cost analysis ; Cost-Benefit Analysis ; Economic models ; Embolization ; Embolization, Therapeutic - economics ; Embolization, Therapeutic - methods ; Endovascular coiling ; Endovascular Procedures - economics ; Endovascular Procedures - methods ; Endovascular stents ; Evaluation ; Health care ; Health risks ; Humans ; Innovations ; Intracranial Aneurysm - economics ; Intracranial Aneurysm - therapy ; Markov Chains ; Medical care ; Medical care, Cost of ; Medicine and Health Sciences ; Mesenchymal stem cells ; Mesenchyme ; Neurosciences ; New technology ; Patient outcomes ; Patients ; Physical Sciences ; Public health ; Quality management ; Quality-Adjusted Life Years ; R&D ; Research & development ; Research and Analysis Methods ; Risk management ; Social Sciences ; Software ; Stem cells ; Technology ; Treatment Outcome ; Uncertainty</subject><ispartof>PloS one, 2021-08, Vol.16 (8), p.e0255870</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Ben-Israel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Ben-Israel et al 2021 Ben-Israel et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c653t-e0ab2470ec1f4a6e9301ab089c83575c0a4aed447905bfb635185eeee6de6c473</citedby><cites>FETCH-LOGICAL-c653t-e0ab2470ec1f4a6e9301ab089c83575c0a4aed447905bfb635185eeee6de6c473</cites><orcidid>0000-0003-1091-4239 ; 0000-0003-2748-4781 ; 0000-0002-6120-5435</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351982/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351982/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34370777$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ben-Israel, David</creatorcontrib><creatorcontrib>Belanger, Brooke L</creatorcontrib><creatorcontrib>Adibi, Amin</creatorcontrib><creatorcontrib>Eesa, Muneer</creatorcontrib><creatorcontrib>Mitha, Alim P</creatorcontrib><creatorcontrib>Spackman, Eldon</creatorcontrib><title>Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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.
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.
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.</description><subject>Aneurysm</subject><subject>Aneurysms</subject><subject>Biology and Life Sciences</subject><subject>Cardiovascular system</subject><subject>Care and treatment</subject><subject>Cell therapy</subject><subject>Complications and side effects</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Economic models</subject><subject>Embolization</subject><subject>Embolization, Therapeutic - economics</subject><subject>Embolization, Therapeutic - methods</subject><subject>Endovascular coiling</subject><subject>Endovascular Procedures - economics</subject><subject>Endovascular Procedures - methods</subject><subject>Endovascular stents</subject><subject>Evaluation</subject><subject>Health care</subject><subject>Health risks</subject><subject>Humans</subject><subject>Innovations</subject><subject>Intracranial Aneurysm - economics</subject><subject>Intracranial Aneurysm - therapy</subject><subject>Markov Chains</subject><subject>Medical care</subject><subject>Medical care, Cost of</subject><subject>Medicine and Health Sciences</subject><subject>Mesenchymal stem cells</subject><subject>Mesenchyme</subject><subject>Neurosciences</subject><subject>New technology</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Physical Sciences</subject><subject>Public health</subject><subject>Quality management</subject><subject>Quality-Adjusted Life Years</subject><subject>R&D</subject><subject>Research & development</subject><subject>Research and Analysis Methods</subject><subject>Risk management</subject><subject>Social Sciences</subject><subject>Software</subject><subject>Stem cells</subject><subject>Technology</subject><subject>Treatment Outcome</subject><subject>Uncertainty</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNkluP0zAQhSMEYpeFf4DAEhKChxYnju2EB1C14lJppZW4vVquM0m8cu1iOy399zg0u2oRD-Qlt2_O-JyZLHua43lOeP7mxg3eSjPfOAtzXFBacXwvO89rUsxYgcn9o-ez7FEINxhTUjH2MDsjJeGYc36e7ZbWuq2M2lmkLRqsHzZx8NCkt-il8tJqaZC0MPh9WCPltNG2e4sWEe16rXq08VoBch5B22ol1R5JD8jCDkVQvXXGdRpCKgxxlhBQUW_h_ePsQStNgCfT_SL7_vHDt8vPs6vrT8vLxdVMMUpSAZarouQYVN6WkkFNcC5XuKpVRSinCstSQlOWvMZ01a4YoXlFIV2sAaZKTi6y5wfdjXFBTJkFkeKqGalrXiRieSAaJ29EcrOWfi-c1OLPB-c7IX3UyoDASmJV4xLjpi1Tj9SRFlBT3gIhtGmT1rup27BaQ6NgzNCciJ7-sboXnduK5Cavq_EwryYB734OEKJY66DAmDQAN4znZmmKdVmNzl78hf7b3UR1MhnQtnXjVEdRsWA8L2hFcpqo1yeUcjbCr9jJIQSx_Prl_9nrH6fsyyO2B2liH5wZxnULp2B5AJV3IXho7zLLsRjX_dacGNddTOueyp4d531XdLvf5DfE8P1Q</recordid><startdate>20210809</startdate><enddate>20210809</enddate><creator>Ben-Israel, David</creator><creator>Belanger, Brooke L</creator><creator>Adibi, Amin</creator><creator>Eesa, Muneer</creator><creator>Mitha, Alim P</creator><creator>Spackman, Eldon</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-1091-4239</orcidid><orcidid>https://orcid.org/0000-0003-2748-4781</orcidid><orcidid>https://orcid.org/0000-0002-6120-5435</orcidid></search><sort><creationdate>20210809</creationdate><title>Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?</title><author>Ben-Israel, David ; Belanger, Brooke L ; Adibi, Amin ; Eesa, Muneer ; Mitha, Alim P ; Spackman, Eldon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c653t-e0ab2470ec1f4a6e9301ab089c83575c0a4aed447905bfb635185eeee6de6c473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aneurysm</topic><topic>Aneurysms</topic><topic>Biology and Life Sciences</topic><topic>Cardiovascular system</topic><topic>Care and treatment</topic><topic>Cell therapy</topic><topic>Complications and side effects</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>Economic models</topic><topic>Embolization</topic><topic>Embolization, Therapeutic - economics</topic><topic>Embolization, Therapeutic - methods</topic><topic>Endovascular coiling</topic><topic>Endovascular Procedures - economics</topic><topic>Endovascular Procedures - methods</topic><topic>Endovascular stents</topic><topic>Evaluation</topic><topic>Health care</topic><topic>Health risks</topic><topic>Humans</topic><topic>Innovations</topic><topic>Intracranial Aneurysm - economics</topic><topic>Intracranial Aneurysm - therapy</topic><topic>Markov Chains</topic><topic>Medical care</topic><topic>Medical care, Cost of</topic><topic>Medicine and Health Sciences</topic><topic>Mesenchymal stem cells</topic><topic>Mesenchyme</topic><topic>Neurosciences</topic><topic>New technology</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Physical Sciences</topic><topic>Public health</topic><topic>Quality management</topic><topic>Quality-Adjusted Life Years</topic><topic>R&D</topic><topic>Research & development</topic><topic>Research and Analysis Methods</topic><topic>Risk management</topic><topic>Social Sciences</topic><topic>Software</topic><topic>Stem cells</topic><topic>Technology</topic><topic>Treatment Outcome</topic><topic>Uncertainty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ben-Israel, David</creatorcontrib><creatorcontrib>Belanger, Brooke L</creatorcontrib><creatorcontrib>Adibi, Amin</creatorcontrib><creatorcontrib>Eesa, Muneer</creatorcontrib><creatorcontrib>Mitha, Alim P</creatorcontrib><creatorcontrib>Spackman, Eldon</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ben-Israel, David</au><au>Belanger, Brooke L</au><au>Adibi, Amin</au><au>Eesa, Muneer</au><au>Mitha, Alim P</au><au>Spackman, Eldon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-08-09</date><risdate>2021</risdate><volume>16</volume><issue>8</issue><spage>e0255870</spage><pages>e0255870-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34370777</pmid><doi>10.1371/journal.pone.0255870</doi><tpages>e0255870</tpages><orcidid>https://orcid.org/0000-0003-1091-4239</orcidid><orcidid>https://orcid.org/0000-0003-2748-4781</orcidid><orcidid>https://orcid.org/0000-0002-6120-5435</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-08, Vol.16 (8), p.e0255870 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2559639972 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Aneurysm Aneurysms Biology and Life Sciences Cardiovascular system Care and treatment Cell therapy Complications and side effects Cost analysis Cost-Benefit Analysis Economic models Embolization Embolization, Therapeutic - economics Embolization, Therapeutic - methods Endovascular coiling Endovascular Procedures - economics Endovascular Procedures - methods Endovascular stents Evaluation Health care Health risks Humans Innovations Intracranial Aneurysm - economics Intracranial Aneurysm - therapy Markov Chains Medical care Medical care, Cost of Medicine and Health Sciences Mesenchymal stem cells Mesenchyme Neurosciences New technology Patient outcomes Patients Physical Sciences Public health Quality management Quality-Adjusted Life Years R&D Research & development Research and Analysis Methods Risk management Social Sciences Software Stem cells Technology Treatment Outcome Uncertainty |
| title | Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective? |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-14T20%3A47%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Innovation%20in%20unruptured%20intracranial%20aneurysm%20coiling:%20At%20which%20price%20or%20efficacy%20are%20new%20technologies%20cost-effective?&rft.jtitle=PloS%20one&rft.au=Ben-Israel,%20David&rft.date=2021-08-09&rft.volume=16&rft.issue=8&rft.spage=e0255870&rft.pages=e0255870-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0255870&rft_dat=%3Cgale_plos_%3EA671258315%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2559639972&rft_id=info:pmid/34370777&rft_galeid=A671258315&rft_doaj_id=oai_doaj_org_article_0ca0c90400df4ee6bfb52e957fe335df&rfr_iscdi=true |