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Objective <p>Elective repair of unruptured intracranial aneurysms (UIAs) has become increasingly safe, yet non-neurological complications remain a concern. Preoperative tests are frequently ordered to uncover occult comorbidities, but routine use in asymptomatic, average-risk patients often adds cost and delay without altering management. We evaluated the cost-effectiveness of common preoperative tests—electrocardiogram (ECG), coagulation and platelet-function testing (PFT), blood glucose panel (BGP), and basic metabolic panel (BMP)—stratified by perioperative risk.</p> Methods <p>Decision-tree models compared performing versus omitting each test for patients undergoing elective UIA treatment. Patients were stratified as high-risk (with cardiac, renal, diabetic, or thromboembolic comorbidities) or average-risk. Lifetime costs and quality-adjusted life years (QALYs) were modeled, discounted at 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) at a $100,000/QALY threshold. Sensitivity analyses tested robustness of the models.</p> Results <p>In high-risk patients, BGP (0.83 QALYs, $2,111; NMB $39,142), ECG (0.81 QALYs, $2,600; NMB $37,844), and BMP (0.79 QALYs, $2,016; NMB $37,465) were cost-effective, each yielding higher effectiveness and lower costs compared with no testing. PFT (0.76 QALYs, $2,841; NMB $35,005) was not cost-effective. In average-risk patients, only BGP showed borderline cost-effectiveness (0.83 QALYs, $649; ICER $172,087; NMB $40,779), while ECG, BMP, and PFT added cost without benefit. Sensitivity analyses confirmed robustness, with probabilistic analysis consistently identifying BGP as the optimal test, particularly in high-risk cohorts. When all tests were modeled together, BGP provided the greatest net benefit.</p> Conclusions <p>Preoperative testing in UIA patients should be selective rather than routine. Targeted testing in high-risk individuals—particularly BGP, ECG, and BMP—provides value, while blanket testing in average-risk patients adds cost and delays without benefit. Risk-based protocols may enhance value-based neurosurgical care by detecting treatable comorbidities when present while avoiding unnecessary interventions in healthy patients.</p>

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What preoperative testing is needed in patients undergoing treatment for unruptured intracranial aneurysms? Optimizing value-based care based on perioperative risk: a cost effectiveness analysis

  • 期刊论文

  • 发表日期：

    2026年3月28日

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  • Naveen Arunachalam Sakthiyendran,
  • Arissa Jokhio,
  • Justin H. Granstein,
  • Christopher S. Ogilvy

摘要

Objective

Elective repair of unruptured intracranial aneurysms (UIAs) has become increasingly safe, yet non-neurological complications remain a concern. Preoperative tests are frequently ordered to uncover occult comorbidities, but routine use in asymptomatic, average-risk patients often adds cost and delay without altering management. We evaluated the cost-effectiveness of common preoperative tests—electrocardiogram (ECG), coagulation and platelet-function testing (PFT), blood glucose panel (BGP), and basic metabolic panel (BMP)—stratified by perioperative risk.

Methods

Decision-tree models compared performing versus omitting each test for patients undergoing elective UIA treatment. Patients were stratified as high-risk (with cardiac, renal, diabetic, or thromboembolic comorbidities) or average-risk. Lifetime costs and quality-adjusted life years (QALYs) were modeled, discounted at 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) at a $100,000/QALY threshold. Sensitivity analyses tested robustness of the models.

Results

In high-risk patients, BGP (0.83 QALYs, $2,111; NMB $39,142), ECG (0.81 QALYs, $2,600; NMB $37,844), and BMP (0.79 QALYs, $2,016; NMB $37,465) were cost-effective, each yielding higher effectiveness and lower costs compared with no testing. PFT (0.76 QALYs, $2,841; NMB $35,005) was not cost-effective. In average-risk patients, only BGP showed borderline cost-effectiveness (0.83 QALYs, $649; ICER $172,087; NMB $40,779), while ECG, BMP, and PFT added cost without benefit. Sensitivity analyses confirmed robustness, with probabilistic analysis consistently identifying BGP as the optimal test, particularly in high-risk cohorts. When all tests were modeled together, BGP provided the greatest net benefit.

Conclusions

Preoperative testing in UIA patients should be selective rather than routine. Targeted testing in high-risk individuals—particularly BGP, ECG, and BMP—provides value, while blanket testing in average-risk patients adds cost and delays without benefit. Risk-based protocols may enhance value-based neurosurgical care by detecting treatable comorbidities when present while avoiding unnecessary interventions in healthy patients.