Surgery 2026

Endovascular coiling (EC) has been identified in systematic reviews and meta-analyses to produce more favourable clinical outcomes in comparison to neurosurgical clipping (NC) when surgically treating a subarachnoid haemorrhage from a ruptured aneurysm. This systematic review aims to perform an economic analysis of the relative utility outcomes and costs from both treatments in the UK. A cost-utility analysis was performed from the perspective of the National Health Service (NHS), over a 1-year analytic horizon. Outcomes were obtained from the randomised International Subarachnoid Aneurysm Trial (ISAT) and measured in terms of the patient’s modified Rankin scale (mRS) grade, a 6-point disability scale that aims to quantify a patient’s functional outcome following a stroke. The mRS score was weighted against the Euro-QoL 5-dimension (EQ-5D), with each state assigned a weighted utility value which was then converted into quality-adjusted life years (QALYs). Costs were measured in pounds sterling (£) and discounted by 3.5% to 2020/2021 prices. The cost-utility analysis showed an ICER of−£144,004 incurred for every QALY gained when EC was utilised over NC. At NICE’s upper willingness-to-pay (WTP) threshold of £30,000, EC offered a monetary net benefit (MNB) of £7934.63 and health net benefit (HNB) of 0.264 higher than NC. At NICE’s lower WTP threshold of £20,000, EC offered an MNB of £7478.63 and HNB of 0.374 higher than NC. EC was found to be more ‘cost-effective’ than NC, with an ICER in the bottom right quadrant of the cost-effectiveness plane—indicating that it offers greater benefits at lower costs.

Alexis Tang is a Singaporean 5th year medical student at the, planning to graduate in 2024. In her 3rd year, she intercalated in Imperial College London for a degree in Healthcare Management, where she completed a group dissertation on pharmacovigilance in social media and published her first paper covering a cost-utility analysis on endovascular coiling versus neurosurgical clipping. She is currently the sponsorship director for Edinburgh University’s Student Surgical society, which is the largest in Scotland, as well as the secretary for Edinburgh University’s Plastic, Reconstructive & Aesthetic Surgery Student society.