Neurology. 2026 Jul 28;107(2):e218267. doi: 10.1212/WNL.0000000000218267. Epub 2026 Jul 2.
ABSTRACT
BACKGROUND AND OBJECTIVES: Subarachnoid hemorrhage (SAH) is associated with high mortality and long-term morbidity, as well as a considerable economic burden. Screening for unruptured intracranial aneurysms (UIAs) has the potential to reduce mortality and disability related to SAH, but whether the related costs are justified and provide true health benefits-either in general or specific high-risk populations-remains unclear. Therefore, we conducted a systematic review to determine whether screening of UIAs has been estimated to be cost-effective in any population.
METHODS: We conducted a literature search in PubMed, Scopus, and Web of Science for studies reporting economic analyses of UIA screening. Eligible studies assessed screening in the general population or in populations with an increased risk of SAH or UIAs. Data were extracted on input parameters, type of model, perspective, and cost-effectiveness outcomes. Study quality was assessed using a modified ECOBIAS checklist.
RESULTS: We included 15 modelling studies from 8 countries, published during 1996-2025. Nine studies evaluated high-risk populations (autosomal dominant polycystic kidney disease, bicuspid aortic valve, coarctation of the aorta, family history, and female smokers), 5 evaluated the general population and 1 examined both. Model input parameters varied widely across studies; assumed UIA prevalence ranged from 0.5% to 19% and annual rupture rates from 0.16% to 12.9%. Twelve studies reported screening as cost-effective (n = 8) or cost-saving (n = 4). All 10 studies evaluating high-risk populations found screening cost-effective. Of 6 studies analyzing screening of general population, 3 concluded it was not cost-effective or was dominated by no screening. All 15 studies were classified as of low quality according to the risk of bias assessment.
DISCUSSION: Current economic analyses suggest that screening is cost-effective for high-risk populations, whereas evidence for general population remains conflicting. However, the evidence consists exclusively of modelling studies, many with important methodologic limitations. Until prospective data better define SAH risk in screened populations and models more accurately reflect the natural history of aneurysms, the economic analyses of screening should be interpreted with caution. Future research should address these limitations and restrict screening strategies to populations with a demonstrated increase in the incidence of SAH rather than with elevated UIA prevalence alone.
PMID:42391598 | DOI:10.1212/WNL.0000000000218267