Introduction: Coils on the U.S. market range in list price from $500 to $3000. Using a clinical decision analytical model, we sought to show potential cost savings with the use of a price capitation model.
Methods: We retrospectively reviewed coil and cost data on 148 patients. We calculated the probabilities of a treated aneurysm being <=/> 10 mm, total number of coils used for a case being <=/>5, and the total length of coil used for a case being <=/> 50 cm. We calculated the mean cost of the currently used coils for all possible combinations of events with the above probabilities. Using the same probabilities, we calculated the expected value of the capped price strategy in comparison to the current one. Multiple one-way and probabilistic sensitivity analyses confirmed the robustness of our results.
Results: Mean aneurysm size was 6.7 mm. A total of 1061 coils were used from a total of 4 different providers. Mean number of coils used for all cases was 7.3. Mean cost for all coils was $10,434. The median total length of coil used, for all coils, was 42 cm. The calculated probabilities of treating an aneurysm less than 10 mm was 0.83, for using less than or equal to 5 coils per case was 0.42, and using coil length less than or equal to 50 cm was 0.89. The expected value of using the capped policy revealed cost-savings of $6564 in comparison to using the price of Company A. Multiple one-way sensitivity analyses revealed that the capped policy was cost-saving if its cost was < $10,500,. In probabilistic sensitivity analyses, the lowest cost difference between current and capped policies was $2750.
Conclusions: Our decision model predicted a minimum $407,000 to a maximum $1,799,976 cost savings in 148 patients by adapting the capped price policy for coils.
Patient Care: My research has the potential to help evaluate the effectiveness of endovascular coiling in the wake of cost-effectiveness and potentially save substantial amounts of money.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of considering the cost of coils in the treatment of intracranial aneurysms 2) Discuss, in small groups, the relevance of clinical decision analysis in studying the costing of hardware for endovascular treatment , 3) Identify an effective methodology to consider and evaluate cost in tandem with effectiveness.