Doig, Christopher J.Manns, BradenBerthiaume, Luc Roger2017-12-182017-12-182009Berthiaume, L. R. (2009). A cost-utility analysis of decompressive hemicraniectomy in patients with malignant middle cerebral artery (mca) infarction (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/3052http://hdl.handle.net/1880/104053Bibliography: p. 84-92Decompressive hemicraniectomy improves survival in patients with large hemispheric strokes and cerebral edema, but a significant proportion of these survivors have moderate to severe disability. Given that decompressive hemicraniectomy is a very resource intensive therapy, whether it offers good value for money is an important question that has not been addressed previously. Our objective was to determine the costs and benefits of decompressive hemicraniectomy in adults with hemispheric strokes associated with cerebral edema and compare these with medical therapy as an alternative treatment strategy. Cost-utility and cost-effectiveness analyses were performed. The performance of decompressive hemicraniectomy in patients with malignant MCA infarction was associated a gain of 2.77 quality adjusted life years (QAL Ys) compared to 0.84 QAL Ys for standard care. The expected cost of a surgical strategy was CAN$ 225 931 compared to CAN$ 101 826 for standard care. The incremental cost per QAL Y gained (ICER) of treating patients with decompressive hemicraniectomy was CAN$ 64 220. When the measure of effectiveness was life years gained, the incremental cost per life year gained was CAN$ 32,180. ii Sensitivity and scenario suggest a likely ICER range of 50,000 to 100,000 dollars per QAL Y gained in appropriately selected patients. Sensitivity analyses suggest that delayed surgery (beyond 48 hours) and surgery performed in older patients could be associated with a much higher ICER. We feel that decompressive hemicraniectomy should be offered to patients with large strokes complicated by cerebral edema as it is a potentially life-saving procedure in a young patient population and it has a similar ICER when compared to therapies that are already funded within the Canadian health care system. Our study results suggest that directing this surgery towards younger patients who can be operated in within 48 hours might optimize use of resources. However, it is associated with an incremental cost and decision makers will need to weight its costs and benefits with other therapies being considered for funding. iiixv, 112 leaves : ill. ; 30 cm.engUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.master thesis10.11575/PRISM/3052