Evidence map›Paper›PMID 33540961›Full record

ArticleJournal of cerebrovascular and endovascular neurosurgery2021

Surgical revascularization for Moyamoya disease in the United States: A cost-effectiveness analysis.

Arvin R Wali, David R Santiago-Dieppa, Shanmukha Srinivas, Michael G Brandel, Jeffrey A Steinberg, Robert C Rennert, Ross Mandeville, James D Murphy, Scott Olson, J Scott Pannell and 1 more

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of cerebrovascular and endovascular neurosurgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.5field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 1 institution in 1 country.

Arvin R WaliDepartment of Neurological Surgery, University of California, San Diego, CA, USA.
David R Santiago-DieppaDepartment of Neurological Surgery, University of California, San Diego, CA, USA.
Shanmukha SrinivasDepartment of Neurological Surgery, University of California, San Diego, CA, USA.
Michael G BrandelDepartment of Neurological Surgery, University of California, San Diego, CA, USA.
Jeffrey A SteinbergDepartment of Neurological Surgery, University of California, San Diego, CA, USA.
Robert C RennertDepartment of Neurological Surgery, University of California, San Diego, CA, USA.
Ross MandevilleDepartment of Neurology, University of California, San Diego, CA, USA.
James D MurphyDepartment of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA.
Scott OlsonDepartment of Neurological Surgery, University of California, San Diego, CA, USA.
J Scott PannellDepartment of Neurological Surgery, University of California, San Diego, CA, USA.
Alexander A KhalessiDepartment of Neurological Surgery, University of California, San Diego, CA, USA.
University of California San Diego · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveMoyamoya disease (MMD) is a vasculopathy of the internal carotid arteries with ischemic and hemorrhagic sequelae. Surgical revascularization confers upfront peri-procedural risk and costs in exchange for long-term protective benefit against hemorrhagic disease. The authors present a cost-effectiveness analysis (CEA) of surgical versus non-surgical management of MMD.

methodsA Markov Model was used to simulate a 41-year-old suffering a transient ischemic attack (TIA) secondary to MMD and now faced with operative versus nonoperative treatment options. Health utilities, costs, and outcome probabilities were obtained from the CEA registry and the published literature. The primary outcome was incremental cost-effectiveness ratio which compared the quality adjusted life years (QALYs) and costs of surgical and nonsurgical treatments. Base-case, one-way sensitivity, two-way sensitivity, and probabilistic sensitivity analyses were performed with a willingness to pay threshold of $50,000.

resultsThe base case model yielded 3.81 QALYs with a cost of $99,500 for surgery, and 3.76 QALYs with a cost of $106,500 for nonsurgical management. One-way sensitivity analysis demonstrated the greatest sensitivity in assumptions to cost of surgery and cost of admission for hemorrhagic stroke, and probabilities of stroke with no surgery, stroke after surgery, poor surgical outcome, and death after surgery. Probabilistic sensitivity analyses demonstrated that surgical revascularization was the cost-effective strategy in over 87.4% of simulations.

conclusionsConsidering both direct and indirect costs and the postoperative QALY, surgery is considerably more cost-effective than non-surgical management for adults with MMD.

Indexed as

Cerebrovascular neurosurgeryCost-effectivenessMoyamoya diseaseStrokeSurgical revascularization

Identifiers

PMID33540961
PMCPMC8041505
OpenAlexW3128855752

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.