LAUSR

Intracranial aneurysms represent a relatively common epidemiological problem, with a prevalence of 3% to 5% in the U.S. Surveillance and treatment remain costly enterprises especially with the advent of safer endovascular techniques, including coiling and pipeline embolization devices (PEDs). While a number of studies have evaluated aneurysm treatment cost, inclusion of follow-up costs had been limited. We sought to examine how follow-up costs after treatment could impact overall cost for different endovascular techniques. The value driven outcomes (VDO) database was used to evaluate the upfront and follow-up costs of electively treated patients who underwent coiling or PED for intracranial aneurysms from July 2011 to December 2017. A total of 114 patients (n = 37 coiled, n = 77 PED) were included with no difference in age (61.3 ± 12.8 vs 57.0 ± 14.5 yr, P = .2), gender (males: 32.4% vs 22.1%, P = .2), American Society of Anesthesiologists (ASA) grade (P = .5), discharge disposition (P = .1), length of stay (3.1 ± 5.5 vs 2.4 ± 2.6 d, P = .2) or follow-up (22.7 ± 18.5 vs 18.6 ± 14.9 mo, P = .2). No differences in admission treatment (P = .5) or follow-up (P = .3) costs were seen for coiling or PED treatments. Initial costs were predominantly supplies/implants (56.1% vs 63.7%) for both coiling and PED. Follow-up costs were mostly facility costs (68.2% vs 67.5%) without differences in supplies/implants (10.5% vs 9.4%) or imaging (17.0% vs 17.8%) costs between coiling and PED. No differences in subgroup (eg, facility, supplies/implants, pharmacy, imaging, laboratory) costs were also observed. These results suggested that coiling or PED could be used for aneurysm treatment in a cost-conscious manner when factoring both upfront and follow-up costs.