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Session: Screening
Room: Meeting Room 21
Time: Thu 10:15-11:30

Presenter: Hendrik Koffijberg (University Medical Center Utrecht. Julius Center for Health Sciences and Primary Care)

Abstract

Introduction: Individuals with a family history of subarachnoid haemorrhage (SAH), defined by two or more affected first-degree relatives, have an increased risk of aneurysm formation and rupture. Screening such individuals for intracranial aneurysms is advocated, but its effectiveness and cost-effectiveness are unknown, as are the optimal age ranges and interval for screening.

Methods: With a Markov model and Monte Carlo simulations we compared screening with no screening in individuals with a family history of SAH. We varied age ranges (starting screening at 20, 30 or 40 years old, ending screening at 60, 70 or 80 years old) and screening intervals (2, 3, 5, 7, 10 and 15 year interval), and analyzed the impact in costs and quality adjusted life years (QALY).

Results: Screening individuals with a family history of SAH is cost-effective. The strategy with the lowest costs per QALY was to screen only twice, at 40 and 55 years old. Sequentially lengthening the screening period and decreasing the screening interval yielded additional health benefits at acceptable costs up to screening from age 20 to 80 every 7 years. More frequent screening within this age range still provided extra QALYs, with an incremental cost-effectiveness ratio more favourable than € 26,308/QALY.

Discussion: This study provides evidence for recommendations to screen individuals with two or more first-degree relatives with SAH. The optimal screening strategy according to our model is screening from age 20 until 80 every 7 years given a cost-effectiveness threshold of € 20,000/QALY.

Key Terms

stroke prevention, cost-utility analysis, subarachnoid haemorrhage, decision analysis, optimization

Authors:

Stijntje Bor (University Medical Center Utrecht. Neurology) , Hendrik Koffijberg (University Medical Center Utrecht. Julius Center for Health Sciences and Primary Care) , Marieke Wermer (Leiden University Medical Center. Neurology) and Gabriel Rinkel (University Medical Center Utrecht. Neurology)

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