ArticleInternational journal of stroke : official journal of the International Stroke Society2025
Cost-effectiveness of population-wide screening for intracranial aneurysms revisited in light of potential diagnostic developments.
Article in International journal of stroke : official journal of the International Stroke Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Association of Diagonal Earlobe Crease (Frank's Sign) with Intracranial Aneurysm Rupture at Small Sizes.Brain sciences · 2026Article
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Authors and funding
4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundPreventive treatment of unruptured intracranial aneurysms (UIAs) has the potential to reduce aneurysmal subarachnoid hemorrhage (SAH) incidence. Population-wide screening (PWS) for UIAs has been disregarded, as it remains unclear how to manage low-risk UIAs. Higher cost for SAH treatment, along with improvements in UIA treatment decision-making, might improve the risk-benefit and cost-benefit ratios for PWS. Currently, blood-based screening tests for UIAs are under development and might be suitable for use in PWS.
aimsThis study sets out to identify what health economic criteria should be met by a hypothetical UIA screening test to justify PWS.
methodsA Markov model was built to compare PWS versus standard of care. Model parameterization was done using real-world data derived from the population cared for by the RWTH Aachen University Hospital. Data in relation to SAH were derived from a prospective registry of consecutive SAH patients (n = 275). In addition, a database of newly diagnosed UIAs was retrospectively collected (n = 139). Incremental cost-effectiveness ratios (ICERs) were calculated to illustrate the annual cost per additional quality-adjusted life year (QALY). Sensitivity analyses were performed to determine at which price point the PWS strategy would become cost-effective based on different levels of willingness-to-pay (WTP).
resultsIn a one-way sensitivity analysis, the price of a hypothetical screening test was varied between €1 and €811.3 (mean cost of magnetic resonance angiography). In case of a WTP of €50,000 per QALY gained, the cost per test may be €225.72 and remain cost-effective. If the same test could also be used for watchful-waiting in low-risk patients (i.e. assess the risk of aneurysm growth), the price may increase up to €294.19. There is no price point at which PWS would become dominant and yield negative ICERs.
conclusionPWS for UIAs is unlikely to be cost-effective, even with new blood screening technologies. However, once patents expire, and price monopolies are broken, use of such technologies may become more attractive for health policymakers, depending on their WTP.
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