Introduction: While many studies have compared the clinical outcomes and efficacy of endovascular and microsurgical treatments of aneurysms, there’s little analysis on cost differences in treatment. Using two national databases, we investigated cost variation in aneurysm treatment.
Methods: For 20,753 unruptured aneurysm patients who were treated via clipping or coiling in the National Inpatient Sample (NIS), we performed survey-weighted univariate and multivariate analyses to calculate national estimates on costs of treatments and to identify patient demographic, clinical, and hospital factors associated with hospital costs. We performed similar analyses with 11,205 patients in the Vizient database.
Results: In the NIS between 2002 and 2013, 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 (all 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 (all P<0.05). In the Vizient database, costs for unruptured aneurysm clipping increased 18% ($37,291 to $44,106), while coiling only increased 7% ($40,741 to $43,533) between 2013 and 2015. Multivariate analyses with Vizient data confirmed that the western United States was the most expensive region in the country for both clipping and coiling (P<0.05).
Conclusions: There is a significant increase and large variation in costs for treatment of unruptured aneurysms. In our analysis of two separate national databases, hospitals in the West had significantly higher costs, even after controlling for patient and hospital factors.
Patient Care: In this era of economic constraints on healthcare, it is increasingly important to identify cost-effective methods for disease management and treatment while continuing to provide high quality care. By analyzing costs of care for aneurysms using national databases, this study identifies important areas that can be improved to contain rising costs for both providers and patients.
Learning Objectives: 1) Understand trends in utilization and costs of ruptured aneurysm treatment 2) Discuss patient demographic, clinical, and hospital factors that underlie cost variation 3) Identify areas of improvement to contain rising costs of ruptured aneurysm treatment