Total Hospital Costs and Length of Stay of Endovascular Coiling Versus Neurosurgical Clipping for Unruptured Intracranial Aneurysms: Systematic Review and Meta-Analysis

Abstract

Comparison of feasibility and safety between endovascular coiling versus neurosurgical clipping for the management of unruptured intracranial aneurysms (UIAs) has been incrementally reported. However, economic comparison has been rarely reported. This meta-analysis aims at qualitatively and quantitatively analyzing the difference of hospital costs and length of stay between endovascular versus neurosurgical treatment in UIA. MEDLINE, the Cochrane database, EMBASE, and Web of Science database were searched for cohort studies describing economic hospital cost or length of stay in patients with UIA. Two authors independently assessed study eligibility and rated quality using the Newcastle Ottawa Scale. Ravmen 5.2 was used to perform forest plot analysis. Nine studies describing 24,856 UIAs treated with neurosurgical clipping and 31,309 UIAs treated with endovascular coiling were included. Meta-analysis revealed that the total hospital costs (THCs) were similar between coiling and clipping in UIA patients (standard mean difference [SMD]:-0.33, 95% confidence interval:-0.68 to 0.02, I2= 99%, P= 0.07). Subgroup analysis showed that THCs of coiling were significantly lower than clipping in the United States but opposite in South Korea. One-year medical costs of coiling were similar in both groups (SMD:-0.04, 95% CI:-0.08 to 0.00, I2= 0%, P= 0.07). In addition, the length of stay of coiling were significantly shorter than that of clipping (SMD: 0.69, 95% CI: 0.56-0.81, I2= 95%, P < 0.001). Generally, no significant difference in THCs and 1-year medical costs between coiling versus clipping in UIAs was observed. However, the length of stay of endovascular coiling was much shorter than neurosurgical clipping and decreased over time.