Survival Benefit and Cost Effectiveness of a Future Blood‐Based Diagnostic Test to Detect Cerebral Aneurysm Formation

Abstract

Background Cerebral aneurysms are common, but there is no blood test for their diagnosis. Cerebral aneurysms are diagnosed incidentally or upon rupture. Current diagnostic tools either are invasive or place a large financial burden on the patient. Introduction of a blood test can reduce costs and allow for additional screening. Methods Markov decision analytic models were created for different case studies to simulate management within the US health care system. The model was run over 50 cycle‐years. Probabilities, costs, and outcomes were obtained from the literature and the National Inpatient Sample database. Quality‐adjusted life years were used to assess outcomes. Subgroup analysis was performed for different risk factors, patient groups, aneurysm size, and family members. Results A blood‐based diagnostic pathway is more cost effective in patients undergoing watchful waiting and as a screening tool in patients who may be at a higher risk. There was a 3‐fold reduction in death compared with the standard of care (15.71% versus 53.10%). The cost of using a blood test per additional quality‐adjusted life year gained was $34 515.13 among the watchful‐waiting cohort. The threshold price was $3951. Among patients with 1 family member with an aneurysm, we observed a 10‐fold reduction in death compared with the standard of care (0.21% versus 2.35%), with a threshold at $845.77. Among patients who smoke, we observed a 10‐fold reduction in death compared with the standard of care (0.27% versus 3.30%) with a threshold at $1054.24. Among patients with 2 family members with an aneurysm, there was a 10‐fold reduction in death compared with the standard of care (0.48% versus 5.85%) with a threshold at $1876.46. Conclusion Introduction of a blood‐based test for cerebral aneurysms would have a lifesaving effect within the US health care system while remaining cost effective.

Keywords

• blood test
• cost effectiveness
• intracranial aneurysm
• Markov model