Direct costs of surgical clipping and endovascular coiling of unruptured intracranial aneurysms.
BACKGROUND
Unruptured intracranial aneurysms can be preventively treated by surgical clipping or endovascular coiling. We determined in detail the costs of these treatments.


METHODS
We included patients who were treated for an unruptured aneurysm between 1997 and 2003. Patients coiled in this period were matched with clipped patients according to the year of treatment, age and gender. Considering clipping and coiling, we compared all pre-admission costs of diagnostic procedures, all costs of treatment, and costs during follow-up including standard angiographic control examinations at 6 and 18 months after coiling. Costs were calculated as the product of the used resources and the costs of these resources.


RESULTS
The mean price for clipping was EUR 8,865.42 and that for coiling EUR 10,370.29. The difference was mainly determined by the higher material costs of coiling (EUR 5,300) compared with clipping (EUR 690). Costs of clipping were mainly determined by the need for intensive care facilities (1.2 days after clipping and 0 days after coiling) and the length of hospital stay (10.5 days after clipping and 3.4 days after coiling). After bootstrapping the data, costs of coiling were on average EUR 1,553 (95% confidence interval: EUR 1,539-1,569) higher than those of clipping.


CONCLUSIONS
For unruptured intracranial aneurysms, direct in-hospital costs of coiling are on average higher than those of clipping, mostly because of the more expensive coils.
Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands. phalkes@umcutrecht.nl
Patricia H A
PH
Halkes
Marieke J H
MJ
Wermer
Gabriël J E
GJ
Rinkel
Erik
E
Buskens
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D003365:Costs and Cost Analysis; D003625:Data Collection; D016527:Drug Costs; D004621:Embolization, Therapeutic / Q000191:economics*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007297:Inpatients; D002532:Intracranial Aneurysm / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics*