Neurointervention.  2016 Sep;11(2):86-91. 10.5469/neuroint.2016.11.2.86.

Cost-Effectiveness Analysis of Endovascular Coiling versus Neurosurgical Clipping for Intracranial Aneurysms in Republic of Korea

• Chang HW
• Shin SH
• Suh SH
• Kim BS
• Rho MH

• KMID: 2350685
• DOI: http://doi.org/10.5469/neuroint.2016.11.2.86

Abstract

PURPOSE
The International Subarachnoid Aneurysm Trial (ISAT) revealed that in ruptured intracranial aneurysms (RA), endovascular coiling (EC) yields better clinical outcomes than neurosurgical clipping (NC) at 1 year. In unruptured aneurysms (UIA), EC is being increasingly used as an alternative to NC due to patients' preference. There is a lot of difference in treatment cost (EC vs. NC) between countries. There is one recently published study dealing with the comparative cost analysis only in UIAs in South Korea. But it is a hospital-based study. So, the authors performed a nation-wide cost effective comparison in our country.
MATERIALS AND METHODS
This study was a retrospective analysis of healthcare big data open systems in Health Insurance Review & Assessment Service (HIRA). Hospital cost data of the recent 5 years (from January 2010 to December 2014) were analyzed according to patients' age and sex and the presence of subarachnoid hemorrhage.
RESULTS
When comparing the total hospital costs for NC of a UIA (n=13,756) and EC of a UIA (n=17,666), NC [mean±standard deviation (SD): ￦7,987,179±3,855,029] resulted in significantly lower total hospital costs than EC [￦10,201,645±5,001,626, p<0.0001], although a shorter hospital stay with EC of a UIA [8.6 ±7.4 days] vs. NC [15.0 ±8.3 days, p<0.0001]. When comparing the total hospital costs for NC of a RA (n=7,293) and EC of a RA (n=6,954), NC [￦13,914,993±6,247,914] resulted in significantly lower total hospital costs than EC [￦16,702,446±7,841,141, p<0.0001], although shorter hospital stays for EC of a RA [19.8 ±11.4] vs. NC [23.0 ±10.3, p<0.0001].
CONCLUSION
The total hospital costs for the NC of both UIAs and RAs were found to be lower than those for EC in South Korea.

Keyword

Intracranial Aneurysm; Hospital Costs; Insurance; Health, Surgical Instruments; Subarachnoid Hemorrhage; Retrospective Studies

MeSH Terms

Aneurysm
Cost-Benefit Analysis*
Costs and Cost Analysis
Delivery of Health Care
Health Care Costs
Hospital Costs
Insurance
Insurance, Health
Intracranial Aneurysm*
Korea
Length of Stay
Republic of Korea*
Retrospective Studies
Subarachnoid Hemorrhage

Figure

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  Fig. 1 Annual number of coiling and clipping in South Korea

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  Fig. 2 Annual total hospital cost of coiling and clipping in South Korea (1= ￦1,000)

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