Article
Surgical management of chronic subdural haematoma – a cost-utility analysis
Chirurgisches Management chronisch Subduralhämatome: eine Kosten-Nutzwert-Analyse
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Published: | May 25, 2022 |
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Objective: Chronic subdural hematoma (cSDH) is a multifactorial disease with a not well understood pathophysiology. High rates of recurrence and postoperative morbidity still represent a financial threat on health systems. Cost-utility analyses (CUA) evaluating health improvement after empiric surgical treatment are lacking. The aim of this study was to perform this analysis and estimate the evolution of treatment's financial impact.
Methods: The authors reported hospital costs of a retrospective cohort of patients with cSDH, surgically treated at their own institution, between January 1st, 2007, and December 31st, 2017. All costs were adjusted for inflation to €2021. The authors searched PubMed for publications describing cumulative excess-mortality and health-related quality of life (HRQoL) after cSDH surgery, reported before July 31st, 2021, then used that data for assessing CUA on their own cohort. Health improvement was expressed in the unit of quality adjusted life years (QALYs) and calculated using a diagram with “lifetime” on X-axis and “HRQoL”, computed from the Mental Health Continuum-Short Form (MHC-SF) total score, on Y-axis.
Results: The data of 728 patients was included. The mean cost per patient was €7,086.18 in 2007, €9,383.08 in 2017, and was estimated to reach €12,369.05 in 2030. The mean cumulative survival was 0.76, corresponding to a mean lifetime of 8.05 years. The mean MHC-SF total score was 46.43/84 after cSDH surgery (HRQoL=0.82, mean follow-up=5.5 years). Healthy age and gender matched controls scored 56.39/84 (HRQoL=1). The estimated QALY-gain through surgery in comparison to “no treatment” was 5.3 QALYs, which by constant QALY-gain, would correspond to €1,337.01/QALY in 2007, €1,770.39/QALY in 2017, and €2,333.78 in 2030.
Conclusion: Because of the expected aging-related worsening of HRQoL and shortening of patients' remaining lifetime, the QALY-gain is likely to decrease. Adding this argument to the imminent mushrooming health-care costs, treatment alternatives are urgently required.