Efficacy and cost-effectiveness analysis of minimally invasive surgeries for basal ganglia hypertensive intracerebral hemorrhage

BACKGROUND: Intracerebral hemorrhage (ICH) is a common stroke subtype with high morbidity and mortality. The optimal surgical approach remains unclear. This study compared the efficacy and cost-effectiveness of three minimally invasive surgeries-endoscopic surgery, frameless navigated aspiration, and small-bone flap craniotomy-in patients with hypertensive basal ganglia ICH. METHODS: In this parallel-group, multicenter randomized trial at 16 centers (July 2016 to June 2022), 515 patients were randomly assigned to endoscopic surgery (n=169), navigated aspiration (n=177), or craniotomy (n=169). The primary outcome was favorable functional outcome (modified Rankin Scale 0-2) at 6 months. Economic evaluation included hospitalization costs and quality-adjusted life years (QALYs). RESULTS: Among the 515 enrolled patients, 468 completed the 6-month follow-up. Favorable outcomes occurred in 29.7% (46/155) of the endoscopy group, 28.1% (45/160) of the aspiration group, and 15.7% (24/153) of the craniotomy group (P=0.007). Mean hospitalization costs were ¥91 517 ($12 853), ¥77 786 ($10 925), and ¥101 208 ($14 214), respectively (P