Introduction: Over the past couple decades, endovascular coiling has become an increasingly popular treatment option for cerebral aneurysms as an alternative to open microsurgical clipping. While studies have compared these interventions based on clinical outcomes and complications, few have analyzed the costs for treating unruptured aneurysms and factors that underlie the variation in costs.
Methods: Using the National Inpatient Sample from 2002 to 2013, we identified 20,753 unruptured aneurysm patients who were treated via clipping or coiling. We performed univariate and multivariate analyses to calculate national estimates on rates and costs of aneurysm treatments and to identify patient demographic, clinical, and hospital factors associated with total hospital costs.
Results: Between 2002 and 2013, the weighted national rate for unruptured clipping increased slightly from 1.21 to 1.29 per 100,000 people) while unruptured coiling increased drastically from 0.52 to 1.9 per 100,000 people. Similarly, the mean inflation-adjusted costs for clipping increased 25% ($26,811 to $33,549) while costs for coiling increased 54% ($21,184 to $32,592). Patients who underwent coiling were more likely to have shorter length of stay, lower risk of mortality, and lower severity of illness than those who underwent clipping (P<0.001). Multivariate analysis showed that female sex, length of stay, risk of mortality, severity of illness, patient’s residence (metropolitan), wage index, and hospitals in the western United States were associated with higher hospital costs for both clipping and coiling procedures (P<0.05).
Conclusions: There is a significant increase and large variation in costs for treatment of unruptured aneurysms. The utilization rate and costs for endovascular coiling increased more quickly than those of microsurgical clipping. Even after controlling for patient and hospital factors, hospitals in the West had significantly higher costs than other regions in the country.
Patient Care: In the current healthcare climate focused on cost-effectiveness and efficiency, this study defines important factors that contribute to variations in cost of care for unruptured aneurysms. Analysis of costs in national scales can help contain rising healthcare costs for both providers and patients.
Learning Objectives: 1) Understand trends in utilization and costs of unruptured aneurysm treatment
2) Discuss patient demographic, clinical, and hospital factors that underlie cost variation
3) Identify areas of improvement to contain rising costs of unruptured aneurysm treatment