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    Survival, Dependency, and Health-Related Quality of Life in Patients With Ruptured Intracranial Aneurysm: 10-Year Follow-up of the United Kingdom Cohort of the International Subarachnoid Aneurysm Trial

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    Author
    Hua, X; Gray, A; Wolstenholme, J; Clarke, P; Molyneux, AJ; Kerr, RSC; Clarke, A; Sneade, M; Rivero-Arias, O
    Date
    2021-02-01
    Source Title
    Neurosurgery
    Publisher
    OXFORD UNIV PRESS INC
    University of Melbourne Author/s
    Hua, Xinyang; Clarke, Philip
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Hua, X., Gray, A., Wolstenholme, J., Clarke, P., Molyneux, A. J., Kerr, R. S. C., Clarke, A., Sneade, M. & Rivero-Arias, O. (2021). Survival, Dependency, and Health-Related Quality of Life in Patients With Ruptured Intracranial Aneurysm: 10-Year Follow-up of the United Kingdom Cohort of the International Subarachnoid Aneurysm Trial. NEUROSURGERY, 88 (2), pp.252-260. https://doi.org/10.1093/neuros/nyaa454.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/252243
    DOI
    10.1093/neuros/nyaa454
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803435
    Abstract
    BACKGROUND: Previous analyses of the International Subarachnoid Aneurysm Trial (ISAT) cohort have reported on clinical outcomes after treatment of a ruptured intracranial aneurysm with either neurosurgical clipping or endovascular coiling. OBJECTIVE: To evaluate the long-term quality-adjusted life years (QALYs) gained of endovascular coiling compare to neurosurgical clipping in the UK cohort of ISAT. METHODS: Between September 12, 1994 and May 1, 2002, patients with ruptured intracranial aneurysms who were assumed treatment equipoise were randomly allocated to either neurosurgical clipping or endovascular coiling. We followed-up 1644 patients in 22 UK neurosurgical centers for a minimum of 10 yr. Health-related quality of life (HRQoL) was collected through yearly questionnaires, measured by utilities calculated from the EQ-5D-3L. We compared HRQoL between the 2 treatment groups over a period of 10 yr. In all, 1-yr, 5-yr, and 10-yr QALYs were estimated by combining utility and survival information. RESULTS: Higher average utility values were found in the endovascular group throughout the follow-up period, with mean differences between groups statistically significant in most years. The 10-yr QALYs were estimated to be 6.68 (95% CI: 6.45-6.90) in the coiling group and 6.32 (95% CI: 6.10-6.55) in the clipping group, respectively, a significant mean difference of 0.36 (95% CI: 0.04-0.66). A third of this mean QALYs gain was estimated to derive solely from HRQoL differences. CONCLUSION: HRQoL after treatment of a ruptured intracranial aneurysm was better after endovascular coiling compared to neurosurgical clipping, which contributed significantly to the QALYs gained over a 10-yr period.

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