Feature
Comparing costs
Application of a cost-effectiveness model in IR planning By Xiao Wu, MD
Yale, looking at intercranial aneurysms. We had a conundrum: up to 3–7% of the general population have intracranial aneurysms and aren’t aware of them unless they get a CTA of the head. Sometimes they’re completely asymptomatic and the aneurysms are often small (2–3 mm).
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When these aneurysms are found, the patients may be referred to neurosurgery or neurointerventionalists and are told they have an aneurysm that could rupture at any time. Do they want to treat it?
Treatment is not without risks either. Physicians must go through vessels
hen I was an undergraduate, I began working with a neuroradiologist at
delicately to coil the aneurysm, which can cause complications, or the patient may undergo open surgery to have the aneurysms clipped. Alternatively, a patient could elect to undergo surveillance of the aneurysms with yearly imaging to track the size or changes in morphology. If so, how often?
It’s a complicated question, and a difficult decision for patients and physicians alike, given all the variables involved. During this time, I came across literature regarding cost- effectiveness analysis and felt it could be a useful model technique to tackle this problem. I took a class at the Yale School of Public Health, purchased related software and began using it— and discovered a powerful tool to help improve both treatment planning and patient consenting.
What are cost-effectiveness analyses? Many people think cost-effectiveness analysis is a complicated mathematical concept, but it’s actually quite simple and straightforward. In essence, you’re comparing multiple strategies.
For ease of illustration let’s say you are looking at two strategies, A and B, to determine their costs and effectiveness. You pick strategy A as a reference strategy and determine if strategy B has achieved an additional benefit for the patient. Then you look at the cost difference. If that added benefit costs $1,000 more, is it worth it? What about $1 million more? Basically, cost-effectiveness is trying to answer that question.
There are multiple ways to calculate cost and effectiveness—and that’s where the complexity can come in. Typical methods include using a cohort study, wherein you look at patient cohorts, survival rates and/or quality of life measurements, and the total medical expenditure of each cohort. Then you average that out in cohort A and cohort B and compare the costs and differences in outcome.
I have more experience in using a modeling-based strategy to calculate the cost and effectiveness. This model
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