J Korean Neurosurg Soc.  2015 Jun;57(6):455-459. 10.3340/jkns.2015.57.6.455.

Comparative Cost Analysis for Surgical and Endovascular Treatment of Unruptured Intracranial Aneurysms in South Korea

• Kim M
• Park J
• Lee J

• KMID: 2191254
• DOI: http://doi.org/10.3340/jkns.2015.57.6.455

Abstract

OBJECTIVE
A cost comparison of the surgical clipping and endovascular coiling of unruptured intracranial aneurysms (UIAs), and the identification of the principal cost determinants of these treatments.
METHODS
This study conducted a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of UIAs between January 2011 and May 2014. The medical records, radiological data, and hospital cost data were all examined.
RESULTS
When comparing the total hospital costs for surgical clipping of a single UIA (n=188) and endovascular coiling of a single UIA (n=188), surgical treatment [mean+/-standard deviation (SD) : Won 8,280,000+/-1,490,000] resulted in significantly lower total hospital costs than endovascular treatment (mean+/-SD : Won 11,700,000+/-3,050,000, p<0.001). In a multi regression analysis, the factors significantly associated with the total hospital costs for endovascular treatment were the aneurysm diameter (p<0.001) and patient age (p=0.014). For the endovascular group, a Pearson correlation analysis revealed a strong positive correlation (r=0.77) between the aneurysm diameter and the total hospital costs, while a simple linear regression provided the equation, y (Won)=6,658,630+855,250x (mm), where y represents the total hospital costs and x is the aneurysm diameter.
CONCLUSION
In South Korea, the total hospital costs for the surgical clipping of UIAs were found to be lower than those for endovascular coiling when the surgical results were favorable without significant complications. Plus, a strong positive correlation was noted between an increase in the aneurysm diameter and a dramatic increase in the costs of endovascular coiling.

Keyword

Endovascular procedures; Hospital costs; Intracranial aneurysm; Surgical procedures

MeSH Terms

Aneurysm
Costs and Cost Analysis*
Endovascular Procedures
Hospital Costs
Humans
Intracranial Aneurysm*
Korea
Linear Models
Medical Records
Retrospective Studies
Surgical Instruments

Figure

• 

  Fig. 1 Graph showing Pearson correlation analysis results between aneurysm diameter and total hospital costs. A : Endovascular group showing strong positive correlation (r=0.77). B : Surgical group showing weak positive correlation (r=0.26).

Reference

1. Birknes JK, Hwang SK, Pandey AS, Cockroft K, Dyer AM, Benitez RP, et al. Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms : morphological considerations. Neurosurgery. 2006; 59:43–52. discussion 43-52PMID: 16823299.

2. Hoh BL, Chi YY, Dermott MA, Lipori PJ, Lewis SB. The effect of coiling versus clipping of ruptured and unruptured cerebral aneurysms on length of stay, hospital cost, hospital reimbursement, and surgeon reimbursement at the university of Florida. Neurosurgery. 2009; 64:614–619. discussion 619-621PMID: 19197221.

3. Hoh BL, Chi YY, Lawson MF, Mocco J, Barker FG 2nd. Length of stay and total hospital charges of clipping versus coiling for ruptured and unruptured adult cerebral aneurysms in the Nationwide Inpatient Sample database 2002 to 2006. Stroke. 2010; 41:337–342. PMID: 20044522.

4. Ioannidis I, Lalloo S, Corkill R, Kuker W, Byrne JV. Endovascular treatment of very small intracranial aneurysms. J Neurosurg. 2010; 112:551–556. PMID: 19715422.

5. Kim BM, Park SI, Kim DJ, Kim DI, Suh SH, Kwon TH, et al. Endovascular coil embolization of aneurysms with a branch incorporated into the sac. AJNR Am J Neuroradiol. 2010; 31:145–151. PMID: 19749218.

6. Koebbe CJ, Veznedaroglu E, Jabbour P, Rosenwasser RH. Endovascular management of intracranial aneurysms : current experience and future advances. Neurosurgery. 2006; 59(5 Suppl 3):S93–S102. discussion S3-S13PMID: 17053622.

7. Lad SP, Babu R, Rhee MS, Franklin RL, Ugiliweneza B, Hodes J, et al. Long-term economic impact of coiling vs clipping for unruptured intracranial aneurysms. Neurosurgery. 2013; 72:1000–1011. discussion 1011-1013PMID: 23612602.

8. Lubicz B, Lefranc F, Levivier M, Dewitte O, Pirotte B, Brotchi J, et al. Endovascular treatment of intracranial aneurysms with a branch arising from the sac. AJNR Am J Neuroradiol. 2006; 27:142–147. PMID: 16418374.

9. Moret J, Pierot L, Boulin A, Castaings L, Rey A. Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils. Neuroradiology. 1996; 38:800–805. PMID: 8957810.

10. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable coil embolization of cerebral aneurysms : 11 years' experience. J Neurosurg. 2003; 98:959–966. PMID: 12744354.

11. Park J, Kang DH, Chun BY. Superciliary keyhole surgery for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy : maximizing symptomatic resolution and minimizing surgical invasiveness. J Neurosurg. 2011; 115:700–706. PMID: 21699478.

12. Radovanovic I, Abou-Hamden A, Bacigaluppi S, Tymianski M. A safety, length of stay, and cost analysis of minimally invasive microsurgery for anterior circulation aneurysms. Acta Neurochir (Wien). 2014; 156:493–503. PMID: 24395051.

13. Wolstenholme J, Rivero-Arias O, Gray A, Molyneux AJ, Kerr RS, Yarnold JA, et al. Treatment pathways, resource use, and costs of endovascular coiling versus surgical clipping after aSAH. Stroke. 2008; 39:111–119. PMID: 18048858.