Abstract TP374: Cost-Effectiveness Framework to Evaluate Therapeutic Interventions Targeting Reduction in Cerebral Infarction Among Aneurysmal Subarachnoid Hemorrhage Patients

BACKGROUND: We developed a framework to assess cost-effectiveness of potential therapeutic interventions t argeting reduction in cerebral infarction in aneurysmal subarachnoid hemorrhage (aSAH) patients prior to investing in high cost randomized controlled trials. METHODS: We estimated the cost and Quality-Adjusted Life Years (QALYs) for 100 hypothetical aSAH patients varying the proportion of patients who develop cerebral infarction (35%, 30%, 25%, and 20%) during initial hospitalization. We estimated both cost and QALYs at 1, 5, and 30-year time. We compared the net costs of therapeutic interventions that cost $5,000, $10,000, $15,000, and $20,000 per patient to simulate costs of existing and potential therapeutic interventions. RESULTS: In the base case in which 35% of the 100 aSAH patients develop cerebral infarction, the total cost was $13,777,940, with total QALYs of 56.9 at 1 year. The total cost was lowest for 100 aSAH patients in the scenario where only 20% of them developed cerebral infarction with total cost estimated at $13,012,653 and QALYs of 60.8 at 1 year. A therapeutic intervention that costs $5,000 per patient (for example: enteral nimodipine, cilostazol or IV 25% humanized albumin alone or in various combinations) was cost effective at 1 year with 10% and 15% reduction in cerebral infarction (compared to the base case) and at 5 years with 5%, 10%, and 15% reduction in cerebral infarction based on a health system expense threshold (willingness to pay) of <$50,000 per QALY gained. A therapeutic intervention that costs $15,000 per patient (for example: IV clazosentan) was cost effective at 5 years only with 15% reduction in cerebral infarction under willingness to pay <$100,000 per QALY. CONCLUSIONS: We present a cost-effectiveness framework which allows pre-trial assessment based on the cost of a therapeutic intervention and the expected magnitude of reduction in occurrence of cerebral infarction in aSAH patients.