Survival Benefit and Cost Effectiveness of a Future Blood-Based Diagnostic Test to Detect Cerebral Aneurysm Formation.

Background: Cerebral aneurysms are common, but there is no blood test for their diagnosis. Cerebral aneurysms are diagnosed incidentally or upon rupture. Current diagnostic tools either are invasive or place a large financial burden on the patient. Introduction of a blood test can reduce costs and allow for additional screening. Methods: Markov decision analytic models were created for different case studies to simulate management within the US health care system. The model was run over 50 cycle-years. Probabilities, costs, and outcomes were obtained from the literature and the National Inpatient Sample database. Quality-adjusted life years were used to assess outcomes. Subgroup analysis was performed for different risk factors, patient groups, aneurysm size, and family members. Results: A blood-based diagnostic pathway is more cost effective in patients undergoing watchful waiting and as a screening tool in patients who may be at a higher risk. There was a 3-fold reduction in death compared with the standard of care (15.71% versus 53.10%). The cost of using a blood test per additional quality-adjusted life year gained was $34 515.13 among the watchful-waiting cohort. The threshold price was $3951. Among patients with 1 family member with an aneurysm, we observed a 10-fold reduction in death compared with the standard of care (0.21% versus 2.35%), with a threshold at $845.77. Among patients who smoke, we observed a 10-fold reduction in death compared with the standard of care (0.27% versus 3.30%) with a threshold at $1054.24. Among patients with 2 family members with an aneurysm, there was a 10-fold reduction in death compared with the standard of care (0.48% versus 5.85%) with a threshold at $1876.46. Conclusion: Introduction of a blood-based test for cerebral aneurysms would have a lifesaving effect within the US health care system while remaining cost effective.