Economic Comparison Between Endovascular Coiling vs Neurosurgical Clipping for Ruptured and Unruptured Intracranial Aneurysms in Austria

Abstract

Abstract INTRODUCTION Subarachnoid hemorrhage from a ruptured intracranial aneurysm poses a significant health hazard due to its high rates of mortality and disability. The 2 most commonly used treatment modalities of intracranial aneurysms are neurosurgical clipping and endovascular coiling. Through the decision on which treatment option should be chosen in every case is made based on medical indication, nevertheless, due to high socioeconomic burden of subarachnoid hemorrhage, it is also important to compare the healthcare expenditures, caused by clipping and coiling. METHODS A comparison of treatment costs of clipping, coiling and stent-assisted coiling (SAC) of ruptured and unruptured aneurysms in Austria was performed. We considered costs of surgery, diagnostic imaging, postoperative in-hospital care, treatment of the complications and initial rehabilitation. Cost-related data was provided by Vienna General Hospital. The length of hospital stay, complications and mortality rates were obtained from previous studies. Based on this information, a decision tree was built. RESULTS Surgery costs of coiling were significantly higher compared to clipping (13.303 98 Euro for Coiling and 24.847 63 Euro for SAC vs 6.835 23 Euro for Clipping). The main cost-driving factors were implants costs. However, clipping caused higher costs of in-hospital stay and initial rehabilitation. Altogether, when considering all in-hospital costs and the cost of rehabilitation treatment, the difference in costs of aneurysm clipping vs coiling was less pronounced. CONCLUSION This study is the first attempt to calculate the costs of aneurysm treatment in Austria. However, the economic comparison is partially based on estimations.