Elective surgery for asymptomatic, unruptured, intracranial aneurysms: A cost-effectiveness analysis

J. T. King, H. A. Glick, T. J. Mason, E. S. Flamm

Research output: Contribution to journalArticlepeer-review

92 Scopus citations


Cost-effectiveness analysis uses both economic and clinical outcomes data to evaluate treatment options. In this era of economic constraints on health care, treatments that are not cost-effective will increasingly be denied public and private insurance reimbursement. The authors used mathematical modeling techniques to assess the cost-effectiveness of elective surgery for the treatment of asymptomatic, unruptured, intracranial aneurysms. Input values for the Markov model used in this study were determined from both the literature and clinical judgment. Direct medical costs for hospitalization and physician fees were derived from Medicare cost reports and resource- based relative-value units, expressed in 1992 U.S. dollars. Costs and benefits were discounted at an annual rate of 5%. Using baseline model assumptions for a 50-year-old patient, elective aneurysm surgery provides an average of 0.88 additional quality-adjusted life years (QALYs) compared with nonsurgical treatment. However, prompt elective surgery ($23,300) costs more than expectant management ($2100), in which only patients whose aneurysms rupture incur treatment costs. Combining the outcomes and cost data, the incremental cost-effectiveness of elective aneurysm surgery is $24,200 per QALY, which is comparable to other accepted medical or surgical interventions, such as total knee arthroplasty ($15,200/QALY) or antihypertensive therapy in a 50-year-old patient ($29,800/QALY). Prompt elective surgery for asymptomatic, unruptured, intracranial aneurysms is recommended as a cost-effective use of medical resources provided: 1) surgical morbidity and mortality remain at reported levels; 2) the patient has a life expectancy of at least 13 additional years; and 3) the patient experiences a decrease in quality of life from knowingly living with an unruptured aneurysm.

Original languageEnglish (US)
Pages (from-to)403-412
Number of pages10
JournalJournal of neurosurgery
Issue number3
StatePublished - 1995
Externally publishedYes


  • Markov model
  • cost-effectiveness analysis
  • decision analysis
  • medical economics
  • unruptured aneurysm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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