Reduced 2-year aneurysm retreatment and costs among patients treated with flow diversion versus non-flow diversion embolization: A Premier Healthcare Database retrospective cohort study

Abstract

Introduction The use of endovascular treatments, including Pipeline embolization devices (PEDs) and coiling approaches (non-PEDs), has played an increasingly important role in the treatment of intracranial aneurysms. Despite multiple studies evaluating PEDs, a real-world evaluation of follow-up outcomes and costs remains to be completed. Methods The Premier Healthcare Database (PHD), 2010-2017, was queried to identify patients with unruptured intracranial aneurysms treated endovascularly. Rates of readmission, retreatment, and cost at the same hospital were compared between patients who underwent PED and non-PED endovascular treatments of their aneurysms. One-to-three (PED-to-non-PED) propensity score (PS) matching was performed to adjust for potential case selection bias into the PED cohort, with covariates including age group, sex, Charlson Comorbidity Index (CCI) group, payor, region, and randomized hospital identifier. Results A total of 679 patients underwent PED placement and 8432 had non-PED treatments. Prior to PS matching, there were significant but minor differences in age (56.7±12.8 vs. 58.2±12.6 years, p = 0.004) and sex (male 16.6% vs. 24.4%, p<0.0001) for PED and non-PED, respectively, but no differences in CCI (p = 0.08), length of stay (p = 0.88), or rate of routine discharge (p = 0.21). All-cause readmission/emergency department reevaluation rates in the two cohorts were similar at 30, 90, and 180 days and 1 and 2 years. Our results identified a significantly lower retreatment rate for PEDs at all follow-up time points over a 2-year period

A Meta-analysis: Cost Comparison of Flow Diversion and Coil Embolization for Intracranial Aneurysm

“…Taken together, flow diversion is an economical and effective method for the treatment of intracranial aneurysms [20]. Consequently, we concluded that the total cost was lower and the retreatment hospitalization costs of flow diversion were higher than coil embolization for the treatment of intracranial aneurysms.…”

“…Despite the higher retreatment hospitalization costs of flow diversion for intracranial aneurysms, the readmission rates and emergency reassessment rates were lower than coil embolization. Taken together, flow diversion is an economical and effective method for the treatment of intracranial aneurysms [ 20 ].…”

Comparison of Pipeline Embolization and Coil Embolization for the Treatment of Large Unruptured Paraclinoid Aneurysms

“…Further, previous studies reported that the need for retreatment was equivalent in both groups. 23,26) Although previous studies included small aneurysms, aneurysms in locations other than the ICA, or FD approaches other than the PED, the reported cost of FD treatment was lower than that for coil embolization, 25,34,35,37,[38][39][40][41] especially when 9 or more coils were required during the coil embolization procedure. 34) However, almost all previous studies reported the costs for the entire hospital stay, including device costs.…”

“…We observed that retreatment was required less frequently in the PED group, a result similar to that in previous studies. 24,25,36,37) However, all previous studies included small aneurysms or aneurysms in locations other than the ICA. Further, previous studies reported that the need for retreatment was equivalent in both groups.…”