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  • Analysis of Neurovascular Aneurysm Treatment Cost-Drivers using the Value Driven Outcome Database

    Final Number:

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

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: The costs involving the treatment of intracranial aneurysms have been widely discussed in the era of cost containment and rapid advent of newer endovascular technologies. We utilized the Value-Driven Outcome (VDO) database at our institution to identifies drivers and changes in cost surgical and endovascular (i.e. coiling and pipeline flow diverters) management of both ruptured and unruptured aneurysms.

    Methods: A retrospective review was performed for surgical and endovascular treatment of rupture and unruptured intracranial aneurysms from 2011 to 2016. Total cost (as a percentage of each patient’s cost to the system), subcategory costs, and potential cost drivers were evaluated.

    Results: A total of 404 patients underwent an aneurysm treatment (n=277 surgically clipped, n=46 coiling, and n=81 pipeline flow diverters). Middle cerebral artery aneurysms accounted for the majority (29.2%) of cases in the clipping group; anterior communicating artery (47.8%) in the coiling group; and internal carotid artery aneurysms (63.0%) 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). Intracranial clipping showed facility costs as being the most significant (59.9%) contributor, followed by supplies (18.5%); coiling also showed facility as the greatest cost-driver (48.4%), followed by supplies (31.3%); while 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 cost on average 2.3X as much as elective patients (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: Medical bills continue to be the number one cause personal bankruptcy in the U.S., and in the treatment of aneurysms especially, cost has not been a completely understood factor. Elucidating the true cost of care, and areas where cost can be improved, may be impactful in reducing the treatment treatment while still maintaining the value of care.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the impact of different aneurysm treatment options in terms of direct cost to the healthcare system, 2) Discuss the impact of aneurysm rupture, relative to elective aneurysms, on treatment cost, 3) Discuss the predominant cot subgroups for aneurysm treatment.


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