Completion angiography for surgically treated cerebral aneurysms: an economic analysis.

OBJECTIVE To compare cost-effectiveness of different strategies for completion angiography after cerebral aneurysm clipping. METHODS A literature search was used to determine the outcome probabilities and costs of various strategies. The pooled results were used in a Markov cost-effectiveness model to compare quality-adjusted life-years and costs of each strategy. Sensitivity (threshold) analyses and Monte Carlo simulation were used to test variation in the model. RESULTS Routine (for all cases) intraoperative angiography proved to be slightly more cost-effective than selective (only for cases deemed "high risk") intraoperative angiography, being both less costly and more effective. Routine postoperative angiography was the least cost-effective. However, in centers whose rates of clip-induced arterial compromise are much lower than the averages reported in the literature, selective angiography might be warranted. CONCLUSION Routine intraoperative angiography remains the most cost-effective form of completion angiography after aneurysm clipping, at least at our present state of technology.