Reducing costs while maintaining quality in endovascular neurosurgical procedures

Abstract

W ith health care reform headlining the media, both the US government and its citizens are acutely aware that funding medical care will continue to be a challenging problem as we face limited supplies and increasing demand. To this end, the cost-effectiveness of managing aneurysms using various endovascular techniques versus open microsurgical management has been much debated. Endovascular treatments are usually considered more costly, especially up-front procedures that include the use of expensive radiology equipment, catheters, and coils. Irrespective of this controversy, once a decision has been made to pursue endovascular management, measures should be undertaken to minimize costs while continuing to provide quality care.Costs associated with neurointerventional procedures can broadly be thought of in 3 categories: preoperative evaluation costs, procedure-related costs, and postoperative care costs. Within each category, several possible means exist for keeping costs down.At the University of Michigan, 3 simple policy changes were made to implement cost-cutting measures for procedure-related items: 1) decreasing the cost of contrast media, 2) optimizing coil prices via negotiation with vendors, and 3) minimizing the amount of opened but unused equipment. Specifically, in October 2008, an active effort was started to allow for the preferential use of Isovue (Bracco) contrast agent over Visipaque (General Electric Healthcare) contrast medium. Object. As medical costs continue to rise during a time of increasing medical resource utilization, both hospitals and physicians must attempt to limit superfluous health care expenses. Neurointerventional treatment has been shown to be costly, but it is often the best treatment available for certain neuropathologies. The authors studied the effects of 3 policy changes designed to limit the costs of performing neurointerventional procedures at the University of Michigan.Methods. The authors retrospectively analyzed the costs of performing neurointerventional procedures during the 6-month periods before and after the implementation of 3 cost-saving policies: 1) the use of an alternative, more economical contrast agent, 2) standardization of coil prices through negotiation with industry representatives to receive economies of scale, and 3) institution of a feedback method to show practitioners the costs of unused products per patient procedure. The costs during the 6-month time intervals before and after implementation were also compared with costs during the most recent 6-month time period.Results. The policy requiring use of a more economical contrast agent led to a decrease in the cost of contrast usage of $42.79 per procedure for the first 6 months after implementation, and $137.09 per procedure for the most current 6-month period, resulting in an estimated total savings of $62,924.31 for the most recent 6-month period. The standardized coil pricing system led to savings of $159.21 per coil after the policy change, and $188.07 per coil in the most recent 6-month period...

Analysis of cerebrovascular aneurysm treatment cost: retrospective cohort comparison of clipping, coiling, and flow diversion

“…Gandhoke and colleagues 5 developed a capped-price model and showed that with capitation of endovascular materials, substantial budget control on supply costs can be achieved. Kashlan et al 8 reported significant budget saving with endovascular interventions when economical contrast media and standardized coil pricing were employed and when medical waste was reduced. Our institution utilizes a neurovascular price-control committee in which these issues are discussed and negotiated with vendors.…”

Operating Costs of Full-endoscopic Lumbar Spine Surgery in Japan

“…When surgeons are given information on procedural and equipment costs, cost savings are realized in response to that feedback. 14,15) The growing interest in the cost of expendable surgical items, number of instruments used, efforts toward efficient use of purchased equipment, and improving technology and endoscopic surgical procedure experience, should further reduce costs. However, the length of hospitalization is short due to the minimally invasive nature of FELD, and will yield no obvious benefits to the hospital.…”

Cost of coils for intracranial aneurysms: clinical decision analysis for implementation of a capitation model

“…Kashlan et al 1 reported on an estimated cost savings of $76,732 after implementing a standardized coil price, calculated by dividing the total cost of all coils used in each 6-month period by the number of coils used. As an example, they state, "Coil A, which may cost $200 from Vendor 1, $400 from Vendor 2, $1000 from Vendor 3, and $800 from Vendor 4, would have an average shelf price of $600."…”