RT期刊文章SR电子T1监测未破裂颅内动脉瘤摩根富林明神经病学神经学乔FD Lippincott Williams &威尔金斯SP e890 OP e903 10.1212 / 首页WNL。99签证官0000000000200785是9 A1蒂姆·亚尼克耐腐蚀合金A1 Myriam M.G. Hunink A1鲁本Dammers A1 Adriaan C.G.M. van Es A1维克多Volovici A1詹姆斯·f·伯克A1 Femke林祖嘉克雷默A1 Diederik j•因为A1鲍勃Roozenbeek年2022 UL //www.ez-admanager.com/content/99/9/e890.abstract AB背景和目标不存在首页共识足够保守的监测管理未破裂颅内动脉瘤(uia)。我们旨在确定最佳MRI监测策略的发展建设史的使用成本效益分析。第二个目标是开发一个临床个体化UIA监视的工具。方法从医疗的角度我们设计了一个微观分析模拟模型模拟100000年55岁的女性估计成本和质量调整生命年(qaly)一生地平线在美国,英国,荷兰,使用literature-derived模型参数。具体国家的成本和愿意支付的阈值(100000美元/美国QALY,£30000 / QALY英国、荷兰和€80000 / QALY)。生命周期成本和qaly每年以3%的折扣对于美国,英国为3.5%,或4%(成本)和1.5% (qaly)荷兰。策略没有后续监测、随访MRI在第一和第五年UIA发现后,每隔5年,每2年,每年或直接干预(即。、剪辑或卷)。利用微观分析模拟模型,我们开发了一个个性化的工具UIA监测为男性和女性,不同年龄和不同动脉瘤的特征。输入参数的不确定性和概率敏感性分析建模。Results Among 55-year-old women, 2,222 individuals in the United States, 1,910 in the United Kingdom, and 2,040 in the Netherlands needed to undergo an annual MRI scan to prevent 1 case of subarachnoid hemorrhage per year. No surveillance MRI was most cost-effective in the United States (in 47% of the simulations) and United Kingdom (in 54% of simulations), whereas annual MRI was most cost-effective in the Netherlands (in 53% of simulations). In the United States and United Kingdom, annual surveillance or surveillance in the first and fifth year after discovery was cost-effective in patients <60 years and at increased risk of aneurysm growth. The optimal, personalized, surveillance strategies were summarized in a look-up table for use in clinical practice.Discussion Generally, the US and UK physicians should refrain from assigning patients, particularly older patients and those with few risk factors for aneurysm growth or rupture, to frequent MRI surveillance. In the Netherlands, annual follow-up is generally most cost-effective.AHA=American Heart Association; ARR=absolute risk reduction; ASA=American Stroke Association; CEAC=cost-effectiveness acceptability curve; CTA=CT angiography; ELAPSS=Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size, and Shape; EVT=endovascular treatment; ICER=incremental cost-effectiveness ratio; ISUIA=International Study of Unruptured Intracranial Aneurysms; MRA=magnetic resonance angiography; PSA=probabilistic sensitivity analysis; QALY=quality-adjusted life year; SAH=subarachnoid hemorrhage; UIA=unruptured intracranial aneurysm; WTP=willingness-to-pay

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