Cost-Effectiveness of Microsurgical Clipping versus Endovascular Coiling in Cerebral Aneurysmal Patient in Korea

Cha, Ki Yong; Kwon, Soon Chan; Park, Sang Keun; Kim, Tae Hong; Shin, Hyung Shik; Hwang, Yong Soon

Abstract

OBJECTIVE: The purpose of this study is to compare the cost-effectiveness of coiling as opposed to clipping in patients with cerebral aneurysm.
METHODS
In this retrospective study, 6032 cases with cerebral aneurysms where were gathered from the Korea Health Insurance Review Agency were treated between January 2001 and September 2002. The cases were divided into two groups according to the treatment protocol : clipping and coiling, and then we did a comparative study of cost-effectiveness between the two groups.
RESULTS
5420 cases and 612 cases underwent clipping and coiling procedures, respectively. The average length of hospitalization day was longer in the clipping group (39.05+/-21.56 days compared with 34.69+/-21.70 days in the coiling group ; p<0.05). The average clinical cost per case was cheaper in the clipping group (9,196,159+/-4,811,659 Won compared with 10,752,703+/-5,856,210 Won in the coiling group ; p<0.05). The average material cost was more expensive in the coiling group (3,548,914+/-2,170,584 Won compared with 235,390+/-131,553 Won in the clipping group ; p<0.05).
CONCLUSION
The results showed that although endovascular coiling of aneurysmal management allows a shorter hospital stay and is less invasive than surgical clipping, it has a higher clinical cost per patient under the present our national insurance. We think that further costs of long term follow-up care, such as periodic diagnostic procedures and re-operation, would be needed.