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  • Cerebral aneurysm coiling: a predictive model of hospitalization cost

    Final Number:
    217

    Authors:
    Kimon Bekelis MD; Symeon Missios MD; Nicos Labropoulos

    Study Design:
    Other

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2015 Annual Meeting

    Introduction: Several initiatives have been put in place to minimize healthcare expenditures. In new and evolving fields such as endovascular aneurysm treatment, there is limited data to support such measures. The objective of the present study was to develop and validate a predictive model of hospitalization cost after cerebral aneurysm coiling (CACo).

    Methods: We performed a retrospective study involving CACo patients who were registered in the Nationwide Inpatient Sample (NIS) database from 2005-2010. The cohort underwent 1:1 randomization to create derivation and validation subsamples. Regression techniques were used for the creation of a parsimonious predictive model.

    Results: Of the 10,928 patients undergoing CACo, 6,617 (60.5%) presented with unruptured, and 4,311 (39.5%) with ruptured aneurysms. The median hospitalization cost was $35,446 (Interquartile Range (IQR), $13,801-$57,091). Common drivers of cost identified in the multivariate analysis included: length of stay, number of admission diagnoses and procedures, hospital size and region, patient income, hydrocephalus, acute renal failure, and seizures. The model was validated in independent cohorts and demonstrated final R2 very similar to the initial model. The predicted and observed values in the validation cohort demonstrated good correlation.

    Conclusions: This national study identified significant drivers of hospitalization cost after CACo. The presented model can be utilized as an adjunct in the cost containment debate and the creation of data-driven policies.

    Patient Care: Recognizing that the initial hospitalization cost is a major component of the overall economic burden of healthcare, several policies have been put in place in an attempt to limit these expenditures. Bundled payment methods and benchmarking of several quality and utilization metrics are part of this drive. The applicability of these national performance-based policies in novel and constantly evolving areas, such as CACo is still vague, given the limited literature on identifiable targets. In this context, we identified drivers of cost for coiling of cerebral aneurysms and created a predictive model of hospitalization cost. This model can be utilized as an adjunct in the cost containment debate and the creation of data-driven policies.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the drivers of cost after cerebral aneurysm coiling 2) Utilize a model for cost prediction after cerebral aneurysm coiling 3) Identify modifiable factors for cost containment

    References: 1. Fisher ES, McClellan MB, Safran DG. Building the path to accountable care. N Engl J Med 2011;365(26):2445-47 2. Reschovsky JD, Hadley J, Saiontz-Martinez CB, Boukus ER. Following the money: factors associated with the cost of treating high-cost Medicare beneficiaries. Health Serv Res 2011;46(4):997-1021 3. Bairstow P, Dodgson A, Linto J, Khangure M. Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms. Australas Radiol 2002;46(3):249-51 4. Brinjikji W, Kallmes DF, Lanzino G, Cloft HJ. Hospitalization costs for endovascular and surgical treatment of ruptured aneurysms in the United States are substantially higher than Medicare payments. AJNR Am J Neuroradiol 2012;33(6):1037-40 5. Brinjikji W, Kallmes DF, Lanzino G, Cloft HJ. Hospitalization costs for endovascular and surgical treatment of unruptured cerebral aneurysms in the United States are substantially higher than medicare payments. AJNR Am J Neuroradiol 2012;33(1):49-51 6. Frontera JA, Moatti J, de Los Reyes KM, et al. Safety and cost of stent-assisted coiling of unruptured intracranial aneurysms compared with coiling or clipping. J Neurointerv Surg 2012;Dec 7. [Epub ahead of print] 7. Halkes PH, Wermer MJ, Rinkel GJ, Buskens E. Direct costs of surgical clipping and endovascular coiling of unruptured intracranial aneurysms. Cerebrovasc Dis 2006;22(1):40-45 8. 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(4):614-19 9. Hoh BL, Chi YY, Lawson MF, Mocco J, Barker FGn. 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(2):337-42 10. Javadpour M, Jain H, Wallace MC, Willinsky RA, ter Brugge KG, Tymianski M. Analysis of cost related to clinical and angiographic outcomes of aneurysm patients enrolled in the international subarachnoid aneurysm trial in a North American setting. Neurosurgery 2005;56(5):886-94

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