A decision tree model in pharmacoeconomic evaluation of surgical and endovascular treatment of intracranial aneurysms


  • V. Georgieva University Hospital Sofiamed Sofia, Bulgaria
  • Zl. Dimitrova Faculty of Chemistry and Pharmacy, Sofia University «St. Kliment Ohridski», Bulgaria
  • E. Petkova Medical University – Plovdiv, Bulgaria
  • K. Andreevska Medical University – Plovdiv, Bulgaria




cerebral aneurysm, surgical and endovascular treatment, alternative therapy


Endovascular [coil] treatment is being used as an alternative to surgical treatment [clipping] for intracranial aneurysms. The purpose of this study was to compare the endovascular treatment and surgical clipping by cost-effectiveness and cost-utility analyses and applying analytical "decision tree" model. The study included 124 patients with intracranial aneurysms from November 2010 to November 2011 (90 underwent surgical clipping, whereas 34 were treated via coiling). Clinical outcome at the 6th month, using the Glasgow Outcome Scale (GOS), and cost of treatment, as well as the quality-adjusted life year (QALY) were evaluated in both groups. In GOS 4 and 5 they were 91.2% of the group treated via coiling and 81.1% of surgically treated patients. Health conditioned quality of life for the first year in 106 patients was: 0,844 QALY for endovascular treatment (27 patients) and 0,737 QALY (79 patients) for surgical treatment. The average cost for patients undergoing endovascular treatment of aneurysms in BGN is estimated at 19,856 while the average price of surgery in BGN is 11,480. There is no statistically significant difference in clinical outcome at the sixth month and in the health conditioned quality of life for the first year after the treatment in both groups. Patients in the endovascular group have had higher rates of intervention than the patients from the surgical group, due to the cost of consumables.


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