Cost Analysis for the Management of Cerebral Aneurysms: Comparison between Clipping and Coiling

Park, Kwang Woo; Park, Cheol Wan; Jun, Young Il; Yoo, Chan Jong; Kim, Young Bo; Park, Chan Woo

Abstract

OBJECTIVE
The aim of this study is to compare the costs for the management of ruptured or unruptured cerebral aneurysms during hospital stay between surgical and endovascular treatment under the Korean national health insurance system.
METHODS
It is a retrospective analysis of 301 cases that had been managed for cerebral aneurysms by clipping and/or coiling at Gil Medical Center from January 2003 to December 2004. Of 301 cases, 37 patients were excluded because they were managed by clipping and coiling at the same hospital stay or for the same aneurysm, had cerebral arteriovenous malformations also, and died during acute postoperative period. The authors analyzed the costs for hospital stay, laboratory test, medications, surgeon's fee, anesthetic fee and disposable medical supplies. We analyzed the costs only for the treatment of cerebral aneurysms and eliminated the expenses for other coexisting diseases, rehabilitation, and long-term follow-up. All statistical analyses were performed by using SPSS software version 11.5 (SPSS Institute Inc., Chicago, IL).
RESULTS
The total number of clipping group was 208 and of coiling was 56. The total mean cost (in Won, \) per patient with ruptured aneurysm in the clipping group and coiling group were \16,986,009+/-\3,037,006 and \18,685,125+/-\4,519,573, respectively. For the unruptured aneurysm, the total mean cost per patient were \16,871,981+/-\3,434,005 in clipping, and \16,383,267+/-\2,480,184 in coiling. Coiling group resulted in shorter hospital stay and less medication, but there was no statistically significant difference in the total mean cost between clipping and coiling.
CONCLUSION
Although coiling group had a shorter hospital stay and less medication costs than clipping group, the total mean cost for coiling was more than clipping without statistical significance because the costs of disposable medical supplies for the coiling were much more expensive than those for the clipping under the current Korean national insurance system.