Cost-effectiveness of clipping vs coiling of intracranial aneurysms after subarachnoid hemorrhage in a developing country—a prospective study

Tahir, Muhammad Zubair; Enam, Syed Ather; Ali, Rushna; Bhatti, Atta; Haq, Tanveer Ul

doi:10.1016/j.surneu.2008.11.003

Cited by 57 publications

(30 citation statements)

References 24 publications

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“…All these studies originate from developed countries where medical insurance covers most of the medical expenses, and where the per capita income is higher than the world average [15]. They concluded that while the endovascular procedure tended to be more expensive in terms of cost of consumables, this expense was more than compensated by savings in staffing costs, and the period and cost of hospitalization [13, 16–19]. …”

Section: Discussionmentioning

confidence: 99%

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Cost of Treatment of Cerebral Aneurysm Embolization: Study of Associated Factors

et al. 2016

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BackgroundSurgical clipping or endovascular coiling are the main procedures used in the treatment of cerebral aneurysms, with a preference for endovascular coiling. In Morocco, the number of patients needing endovascular coiling is growing, but many of them do not have access to this technique. The aim of this study was to determine the main parameters associated with variations in the total cost of this procedure in order to establish the amount (lump sum) that may be reimbursed by health insurance funds.MethodsOne hundred and seventeen patients with 124 aneurysms were admitted for treatment of one or more intracranial aneurysms between January 2010 and December 2015. The overall cost of hospitalization was assessed by using the micro-costing technique. The calculation was based on the tariffs of medical procedures as defined by the Ministry of Health in Morocco. A regression analysis was used to define the correlation between the overall cost and the various parameters.ResultsUnivariate linear regression showed that the total cost was influenced by overall duration of hospitalization, ICU duration of hospitalization and size of aneurysm. On the other hand, univariate linear regression showed that the total cost was not influenced by sex, localization of aneurysm, and size of the aneurysm’s neck. However, multivariate linear regression showed that the total cost was influenced by one type of insurance health, overall duration of hospitalization, ICU duration of hospitalization, size of the aneurysm, and size of the aneurysm’s neck.ConclusionSetting a rate for reimbursement of patients who have had coiling treatment for a cerebral aneurysm should take into account the results of our study in order to limit the costs borne by patients. The parameters that influence the overall cost must be reimbursed in each case while the parameters that do not influence treatment costs could be included in a lump sum.

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Section: Discussionmentioning

confidence: 99%

“…In France, it was assessed as 14,477.39 € [12]. In Pakistan, the average cost of endovascular treatment was estimated at € 5080 [13]. …”

Section: Introductionmentioning

confidence: 99%

Cost of Treatment of Cerebral Aneurysm Embolization: Study of Associated Factors

et al. 2016

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“…[7][8][9][10][11][12][13][14][15][16][17] Several studies have analyzed the economic aspects of cerebral aneurysm interventions. [18][19][20][21][22][23] However, the generalizability of their findings is limited because most authors failed to adjust appropriately for measured or unmeasured confounders. Some are single-center [18][19][20] or international experiences [21][22][23] whereas others have utilized charges as a surrogate for cost 24 and are therefore not reflecting the true financial impact of these procedures.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20][21][22][23] However, the generalizability of their findings is limited because most authors failed to adjust appropriately for measured or unmeasured confounders. Some are single-center [18][19][20] or international experiences [21][22][23] whereas others have utilized charges as a surrogate for cost 24 and are therefore not reflecting the true financial impact of these procedures. Several investigators have focused only on hospitalization cost, which does not take into account the cost of possible future reintervention in endovascularly-treated patients or the cost of longterm care in patients experiencing complications.…”

Section: Introductionmentioning

confidence: 99%

Medicare expenditures for elderly patients undergoing surgical clipping or endovascular intervention for unruptured cerebral aneurysms

Bekelis

Gottlieb

et al. 2016

J NeuroIntervent Surg

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Background The cost difference between the two treatment options (surgical clipping and endovascular therapy) for unruptured cerebral aneurysms remains an issue of debate. We investigated the association of treatment method for unruptured cerebral aneurysms and Medicare expenditures in elderly patients. Methods We performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients, who underwent treatment for unruptured cerebral aneurysms from 2007 to 2012. In order to control for measured confounding, we used multivariable regression analysis with mixed effects to account for clustering at the HRR level. An instrumental variable (regional rates of endovascular treatment) analysis was used to control for unmeasured confounding by creating pseudo-randomization on the treatment method. Results During the study period, there were 8,705 patients, who underwent treatment for unruptured cerebral aneurysms, and met the inclusion criteria. Of these, 2,585 (29.7%) had surgical clipping, and 6,120 (70.3%) had endovascular treatment. The median total Medicare expenditures in the first year after the admission for the procedure were $46,800 (IQR $31,000 to $74,400) for surgical clipping, and $48,100 (IQR $34,500 to $73,900) for endovascular therapy. When we adjusted for unmeasured confounders, using an instrumental variable analysis, clipping was associated with increased 7-day Medicare expenditures by $3,527 (95% CI, $972 to $5,736) and increased 1-year Medicare expenditures by $15,984 (95% CI, $9,017 to $22,951). Conclusions In a cohort of Medicare patients, after controlling for unmeasured confounding, we demonstrated that surgical clipping of unruptured cerebral aneurysms was associated with increased 1-year expenditures in comparison to endovascular treatment.

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“…Some have been retrospective analyses of single institution experiences,6–8 demonstrating results with limited generalization, given their inherent selection bias. Other investigations have focused on patients from the International Subarachnoid Aneurysm Trial study14 or other international centers,3 10 12 13 15 with restricted applicability to the US healthcare market. Multicenter studies based on US data4 5 8 9 11 did not analyze modifiable drivers of cost after CACo or develop a model for cost approximation.…”

Section: Introductionmentioning

confidence: 99%

Cerebral aneurysm coiling: a predictive model of hospitalization cost

Bekelis

Missios

Labropoulos

2014

J NeuroIntervent Surg

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Cost-effectiveness of clipping vs coiling of intracranial aneurysms after subarachnoid hemorrhage in a developing country—a prospective study

Cited by 57 publications

References 24 publications

Cost of Treatment of Cerebral Aneurysm Embolization: Study of Associated Factors

Cost of Treatment of Cerebral Aneurysm Embolization: Study of Associated Factors

Medicare expenditures for elderly patients undergoing surgical clipping or endovascular intervention for unruptured cerebral aneurysms

Cerebral aneurysm coiling: a predictive model of hospitalization cost

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