Abstract W P77: In-Depth Comparison of Short-Term Total Hospital Costs and Current Primary Cost Drivers of Coiling vs Clipping for Unruptured Intracranial Aneurysms.

Abstract

Objective: The goal of our study is to perform an in-depth cost comparison between index hospitalizations of patients with unruptured intracranial aneurysms (UIA’s) treated with either endovascular coil embolization or surgical clipping to identify the current primary drivers of costs of either management approach. Methods: We obtained detailed breakdowns of index hospitalization costs associated with 125 cases of UIA’s treated with either endovascular coil embolization or surgical clipping from 2010 to 2012 at University Hospitals Case Medical Center. We obtained patient demographics and aneurysm characteristics from our clinical database. We performed cost comparisons that were stratified based on patient age, patient gender, aneurysm size, and aneurysm location. Using multiple linear regressions, we also identified clinical parameters that significantly contribute to total hospital costs. Results: Of the 125 cases we identified, 69 were treated with surgical clipping and 56 were treated with coil embolization. Average total hospital costs for clipping was lower than coiling (p = 0.003). Average fixed direct costs and fixed indirect costs for clipping were higher than coiling (p < 0.001, p < 0.001 respectively). Average variable direct costs for clipping were significantly lower than coiling (p < 0.001). The average proportions of total hospital costs accounted for by variable direct costs for clipping and coiling were 50.5% and 68.6% respectively (p < 0.001). Average length of stay for clipping was longer than coiling (p < 0.001). Our regression results demonstrate that for surgical clipping, patient length of stay (p < 0.001), aneurysm size (p = 0.01), and patient age (p = 0.02) were significant contributors to total hospital costs. For coil embolization, only length of stay (p < 0.001) was a significant contributor to total hospital costs. Conclusion: Although surgical clipping of UIA’s is associated with longer hospitalizations, the total index hospitalization costs associated with clipping are lower than those associated with coiling. Length of stay, patient age, and aneurysm size were all significant drivers of total costs for clipping. Variable direct cost is the main driver of total costs for coiling.