Treatment pathways, resource use, and costs of endovascular coiling versus surgical clipping after aSAH.
OBJECTIVE
The International Subarachnoid Aneurysm Trial (ISAT) reported that endovascular coiling yields better clinical outcomes than surgical clipping at 1 year. The high cost of the consumables associated with the endovascular coiling procedure (particularly the coils) led health care purchasers to conclude that coiling was a more costly procedure overall. To examine this assumption and provide evidence for future policy, accurate and comprehensive data are required on the overall resource usage and cost of each strategy.


METHODS
We provide detailed results of patient treatment pathways, resource utilization, and costs up to 24 months postrandomization for endovascular and neurosurgical treatment of aSAH. We report data on costs related to initial and subsequent procedures (ward days, ITU, equipment, staff, consumables, etc), adverse events, complications, and follow up. The data are based on a subsample of all patients randomized in ISAT, containing all patients across 22 UK centers (n=1644).


RESULTS
There was a nonsignificant difference - pound 1740 (- pound 3582 to pound 32) in the total 12-month cost of treatment in favor of endovascular treatment. Endovascular patients had higher costs than neurosurgical patients for the initial procedure, for the number and length of stay of subsequent procedures, and for follow-up angiograms. These were more than offset by lower costs related to length of stay for the initial procedure. In the following 12- to 24-month period, costs for subsequent procedures, angiograms, complications, and adverse events were greater for the endovascular patients, reducing the difference in total per patient cost to - pound 1228 (- pound 3199 to pound 786) over the first 24 months of follow-up.


CONCLUSIONS
No significant difference in costs between the endovascular and neurosurgery groups existed at 12- or 24-month follow up.
Health Economics Research Centre, Department of Public Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK. jane.wolstenholme@dphpc.ox.ac.uk
Jane
J
Wolstenholme
Oliver
O
Rivero-Arias
Alastair
A
Gray
Andrew J
AJ
Molyneux
Richard S C
RS
Kerr
Julia A
JA
Yarnold
Mary
M
Sneade
D000792:Angiography / Q000191:economics; D003365:Costs and Cost Analysis; D019091:Critical Pathways; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000191:economics*; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000191:economics / Q000601:surgery*; D013525:Surgical Instruments / Q000009:adverse effects / Q000191:economics; D006113:United Kingdom; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods