ISC 2026 | Cost-effectiveness framework to evaluate therapies in aneurysmal subarachnoid hemorrhage

Many therapies have been developed to reduce the risk of cerebral ischemia in aneurysmal subarachnoid hemorrhage. And cerebral ischemia obviously happens through a multitude of factors. So there is narrowing of the blood vessel, which we call vasospasm. There are changes in very small blood vessels in the brain, and obviously there is an enhanced clotting of the blood. So essentially all of that combined together causes cerebral ischemia. And numerous therapeutic interventions have been developed and are being developed to reduce the risk of cerebral ischemia because that can potentially improve the outcomes or reduce the death and disability seen with patients with aneurysmal subarachnoid hemorrhage. Now, the problem so far has been that a therapeutic intervention is developed first and then actually validated whether it was truly a cost-effective intervention or not. So what we did was we said we can actually understand the magnitude or the effect of reduction in cerebral infarction in aneurysmal subarachnoid hemorrhage patients, what it means in terms of the cost, the cost of care, and the quality of life years. And we can create a model. So you can actually evaluate any therapeutic intervention, even before you start a clinical trial or even you put it through clinical evaluation, whether the cost of that intervention would really become cost-effective and the magnitude of reduction and all of that put together in an equation so you can actually decide whether this intervention is going to be cost-effective or not and decide whether to pursue it further or not into clinical investigation which actually in itself is a huge cost burden. So essentially we created this model, and we looked at, you know, whether a therapeutic intervention will be cost-effective at one year, five years, and even 30 years, depending on the magnitude of reduction of cerebral dysfunction in aneurysmal subarachnoid hemorrhage, and then actually putting a cost value and the quality of life value on each of that reduction. And essentially, based on that model, we were able to create that certain therapeutic interventions, if the cost is like $5,000 per patient, are going to be highly effective at one year, five years, and 30 years, and the cost of therapeutic intervention that may cost $20,000 to $30,000 per patient will only be effective if they have a large reduction in cerebral infarction and maybe even be cost-effective at 5 or 30 years.

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