Abstract
Both endovascular and surgical options are available for treatment of unruptured cerebral aneurysms. We conducted a study to determine the costs versus Medicare reimbursement for hospitalization of these patients, which is important information for understanding the economic impact of these patients on hospitals. Using the NIS, we identified hospitalizations for clipping and coiling of unruptured cerebral aneurysms from 2001 to 2008 by cross-matching ICD-9 codes for diagnosis of unruptured aneurysm with procedure codes for clipping or coiling of cerebral aneurysms and excluding all patients with subarachnoid hemorrhage and intracerebral hemorrhage. Hospital costs for 2008 were correlated with age, sex, and discharge status and compared with Medicare payments. Costs of both clipping and coiling have increased from 2001 to 2008. The median 2008 hospital costs were $23,574 (IQR, $18,233-$29,941) for clipping and $25,734 (IQR, $17,436-$35,846) for coiling without complications, which were higher than the average Medicare payment of $12,599. The median hospital costs were $36,188 (IQR, $21,831-$55,308) for clipping and $40,502 (IQR, $24,289-$50,108) for coiling treatments complicated by major morbidity and $68,165 (IQR, $32,972-$100,211) for clipping and $56,020 for coiling treatments complicated by mortality, which were higher than the average Medicare payment for patients with major complications and comorbidities of $22,946. In multivariate analysis, female sex was associated with higher costs for coiling (P = .02), and poor discharge status was associated with higher costs for both clipping (P < .001) and coiling (P < .001). Hospitalization costs for patients undergoing clipping and coiling of unruptured cerebral aneurysms are substantially higher than Medicare payments.
Highlights
MethodsUsing the NIS, we identified hospitalizations for clipping and coiling of unruptured cerebral aneurysms from 2001 to 2008 by cross-matching ICD-9 codes for diagnosis of unruptured aneurysm with procedure codes for clipping or coiling of cerebral aneurysms and excluding all patients with subarachnoid hemorrhage and intracerebral hemorrhage
AND PURPOSE: Both endovascular and surgical options are available for treatment of unruptured cerebral aneurysms
The median 2008 hospital costs were $23,574 (IQR, $18,233–$29,941) for clipping and $25,734 (IQR, $17,436 –$35,846) for coiling without complications, which were higher than the average Medicare payment of $12,599
Summary
Using the NIS, we identified hospitalizations for clipping and coiling of unruptured cerebral aneurysms from 2001 to 2008 by cross-matching ICD-9 codes for diagnosis of unruptured aneurysm with procedure codes for clipping or coiling of cerebral aneurysms and excluding all patients with subarachnoid hemorrhage and intracerebral hemorrhage. Hospital costs for 2008 were correlated with age, sex, and discharge status and compared with Medicare payments. Patient Population We collected and analyzed data from the NIS hospital discharge data base for 2001–2008, which were acquired from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, Rockville, Maryland. The NIS is a hospital discharge data. We examined the correlation between the following variables and total costs in 2008: age, sex, and discharge status (home/short-term facility, long-term facility, and in-hospital death). Medicare costs are public information (http://www.cms.hhs.gov) and were compared with the 2008 hospitalization cost data. We present medians and IQRs rather than means and SDs because the data were not normally dis-
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