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  • Analysis of Cost Drivers of Neurovascular Aneurysm Treatment

    Final Number:

    Hussam Abou-Al-Shaar MD; Spencer Twitchell BS; Jared Reese BS; Michael Karsy; Jian Guan MD; Philipp Taussky MD; William T. Couldwell MD, PhD

    Study Design:

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2018 Annual Meeting

    Introduction: With the continuous attention on healthcare costs, hospitals and healthcare providers must find ways to reduce costs while maintaining high-quality care. Comparison of surgical and endovascular (i.e., coiling and flow diverters) treatment of intracranial aneurysms has been an area of interest in the effort to reduce costs in neurosurgery. The Value-Driven Outcome (VDO) database at the University of Utah identifies cost drivers and tracks changes over time. We evaluated specific cost drivers for surgical and endovascular management of both ruptured and unruptured intracranial aneurysms using the VDO system.

    Methods: The authors performed a retrospective review of surgical and endovascular treatment of ruptured and unruptured intracranial aneurysms from July 2011 to May 2016. Total cost (as a percentage of each patient’s cost to the system), subcategory costs, and potential cost drivers were analyzed.

    Results: A total of 404 patients underwent aneurysm treatment: 277 aneurysms were surgically clipped, 46 were repaired with coiling, and 81 were addressed with Pipeline stent placements. Aneurysms of the middle cerebral artery accounted for most (29.2%) of cases in the clipping group; those of the anterior communicating artery were predominant (47.8%) in the coiling group; and those of the internal carotid artery (63.0%) were most common in the Pipeline stenting group. Intracranial aneurysm surgical clipping had a mean total cost of 0.245±0.20%, coiling had a mean total cost of 0.28±0.24%, and Pipeline stenting had a mean total cost of 0.23±0.21% (P = 0.51, one-way ANOVA). Facility costs were the most significant (59.9%) contributor to intracranial clipping costs, followed by supplies (18.5%); coiling also showed facility as the greatest cost driver (48.4%), followed by supplies (31.3%). Pipeline stent placement was unique in that supplies were the greatest influence on total cost (65.9%), followed by facility (21.8%). Patients presenting with ruptured aneurysms had an average 2.3 times greater cost than patients treated electively (unruptured aneurysms) (P = 0.0001, t-test).

    Conclusions: Facility utilization and supplies constitute the major factors for total costs in aneurysm treatment strategies. Developing and implementing approaches and protocols to mitigate the total costs and improve resource utilization are important in reducing costs while maintaining high-quality patient care.

    Patient Care: When healthcare providers consider costs, they are serving the real interests of their patients. Our study addresses the financial aspect of aneurysm treatment strategies and propose approaches and protocols to mitigate the total costs and improve resource utilization are important in reducing costs while maintaining high-quality patient care.

    Learning Objectives: 1. To evaluate specific cost drivers for surgical and endovascular management of both ruptured and unruptured intracranial aneurysms using the Value-Driven Outcome (VDO) system. 2. To propose approaches and protocols to mitigate the total costs and improve resource utilization are important in reducing costs while maintaining high-quality patient care.

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