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Economic evaluation alongside ISAT: a trial of endovascular therapy versus neurosurgical therapy in aneurysmal subarachnoid haemorrhage

Dates: 1996-2007
Funding: Medical Research Council
Collaborators: Neurovascular Research Unit, Nuffield Department of Surgery, University of Oxford; Oxford Radcliffe NHS Trust.
Information: Oliver Rivero-Arias and Jane Wolstenholme

Aneurysmal subarachnoid haemorrhage (aSAH) is a severe event which affects adults in the 30-60 age groups, who previously were completely well. Hence its consequences to the patient and family may be devastating.

ISAT is a multinational randomised controlled trial which has demonstrated that endovascular treatment has a lower mortality and morbidity than neurosurgery in acutely ruptured intracranial aneurysms. These results have changed clinical practice worldwide.

HERC is working on the long-term cost-effectiveness using five year follow-up data. Detailed resource use data on treatment, length of stay at various inpatient facilities, readmissions and follow-up costs are available. Information on employment-related and informal data have also been collected. The primary outcome measure in this analysis is life-years gained and quality-adjusted life years gained. Quality of life is measured using the EuroQol (EQ-5D) instrument at different follow-up periods.
HERC’s analysis of UK costs at two year follow-up found similar overall healthcare costs in both treatment groups, and was published in Stroke in 2008.

Publications

Rivero-Arias, O, Wolstenholme, J, Gray, A, Molyneux, A, Kerr, R, Yarnold, J, and Sneade, M (2009). The costs and prognostic characteristics of ischaemic neurological deficit due to cerebral vasospasm in the United Kingdom: Evidence from the MRC International Subarachnoid Aneurysm Trial. Journal of Neurology, 256(3):364-73

Wolstenholme, J, Rivero-Arias, O, Gray, A, Molyneux, AJ, Kerr, RS, Yarnold, JA and Sneade, M (2008). Treatment Pathways, Resource Use, and Costs of Endovascular Coilng Versus Surgical Clipping after aSAH. Stroke, 39(1):111-9.