Survival Benefit and Cost-Effectiveness Analysis of a Future Blood-Based Diagnostic Test to Detect Cerebral Aneurysm Formation: A hypothetical modeling study

Abstract IMPORTANCE: Cerebral aneurysms are typically diagnosed incidentally or upon rupture. In this study we aimed to investigate cost-effectiveness of a hypothetical blood-based diagnostic test to detect cerebral aneurysm formation in the US healthcare model. DESIGN: Markov decision analytic models were created for four different case studies to simulate management of cerebral aneurysm diagnosis within the US healthcare system over 50 years. To assess robustness, we performed sensitivity analyses. Further analysis was performed for different risk factors, patient groups, and aneurysm size. INTERVENTIONS: Standard care, thrice-annually blood test monitoring, annual blood testing among high-risk groups. RESULTS: A blood based diagnostic test pathway is more cost effective in patients undergoing watchful-waiting and as a screening tool in patients at a higher-risk of developing an aneurysm when compared to the traditional pathway. Our analysis demonstrated a greater than three-fold reduction in mortality compared to the standard of care (SOC) (15.71% vs 53.10%, respectively). The cost of using a blood test per additional QALY gained was estimated to be $34,515.13 among the watchful-waiting cohort. The threshold price for cost-effectiveness of a blood test was determined to be $3,951. Among patients with one family member with an aneurysm and smokers, we observed a near tenfold reduction in mortality compared to the SOC (0.21% vs 2.35%, and 0.27% vs 3.30 %, respectively) with a threshold at $865.23 and $1,078.48. CONCLUSIONS: Introduction of a hypothetical blood-based diagnostic test to detect cerebral aneurysm formation would have a life-saving effect within the US healthcare system while remaining cost-effective.