Longitudinal Cost Profiles of Pipeline Embolization Device Versus Stent-Assisted Coiling in Propensity-Matched Unruptured Small Anterior Circulation Aneurysms.

Abstract

The cost profiles of stent-assisted coiling (SAC) vs Pipeline embolization device (PED) in small unruptured anterior circulation aneurysms have not been studied. To compare the 2 modalities cost profiles in a propensity-matched cohort controlling for potential technical complexity confounders including size and location. Patients treated with either SAC or PED at our institution were identified. Following propensity-score algorithm, 46 patients, 23 in each group were matched. The procedural and follow-up costs in each group were analyzed and compared. Median maximal aneurysm size in the SAC and PED cohort were 5.3vs 5.1mm, respectively. Costs of access guide materials were significantly higher in the SAC group (P <.01). The average implant cost was not significantly different between the SAC and PED cohorts (${\$}$13973.2 ± ${\$}$2886.2vs ${\$}$14,760.7 ± ${\$}$3782.1, respectively; P=.43). Similarly, total procedural costs were not different (${\$}$18341.5 ± 4104vs ${\$}$17484.3±2914.1, respectively, P=.42). Although there were significantly more total follow-ups (P=.02) and longer follow-up duration (P=.01) in SAC cohort, no significant difference in follow-up costs between the 2 groups was identified (${\$}$20557 ± ${\$}$9247vs ${\$}$18958 ± ${\$}$9171.9, P=.56). Overall cost was similar between the SAC (${\$}$38898.9 ± ${\$}$9645.5) and PED groups (${\$}$36442.4 ± ${\$}$9076) (P=.38). In small unruptured anterior circulation aneurysms (excluding anterior communicating artery aneurysms) matched for technical complexity confounders, SAC and PED offer an overall equivalent economic cost profile. Postprocedural noninvasive imaging was more frequent in the SAC group. However, follow-up costs and total costs were not significantly different.