title: Treatment of large and giant intracranial aneurysms: cost comparison of flow diversion and traditional embolization strategies.
abstract: OBJECTIVE
  Flow diversion has emerged as a promising strategy for management of intracranial aneurysms. The purpose of this study was to determine whether treatment of large and giant aneurysms with the pipeline embolization device (PED) is more economical than traditional embolization strategies.
  
  
  METHODS
  We identified 30 consecutive aneurysms larger than 10 mm that were treated with PED at our institution. For each aneurysm treated with PED, theoretical coil embolization was performed by filling volume in a consistent, stepwise fashion until a packing density of 25% was reached. Prices of all equipment and implants were taken from price lists provided by each manufacturer.
  
  
  RESULTS
  Median aneurysm volume was 0.90 cm(3). Overall procedure cost was lower with the PED (mean, $23,911) vs. coiling ($30,522, P = .06). Above the median aneurysm volume, PED treatment was significantly less expensive than coiling even if multiple PEDs were used (P = .006). However, below the median aneurysm volume, PED treatment was significantly more expensive than coiling (P = .009). Treatment with multiple PEDs was not cost-beneficial compared with coiling, even above the median aneurysm volume. Potential savings associated with the PED were highly dependent on the type of embolic agent used.
  
  
  CONCLUSIONS
  The cost of initial treatment of large and giant aneurysms with PED is economically favorable compared to traditional embolization techniques. However, any potential cost benefit depends on aneurysm volume, coil type, and number of PEDs used. Accordingly, PED therapy is more expensive than coiling in aneurysms <0.9 cm(3) or when multiple devices are used.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: el-Chalouhi
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Jabbour
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Stavropoula I
authors.initials: SI
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.affiliation: Department of Radiation Oncology, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Haisong
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Sedeek
authors.initials: S
authors.lastname: El Moursi
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA. Electronic address: fernando.gonzalez@jefferson.edu.
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
mesh_terms: D015901:Angiography, Digital Subtraction; D057785:Catheters / Q000191:economics; D002548:Cerebral Revascularization / Q000191:economics / Q000295:instrumentation; D017046:Cost Savings; D004121:Dimethyl Sulfoxide / Q000191:economics / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000191:economics* / Q000295:instrumentation*; D017721:Hospital Costs; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D011145:Polyvinyls / Q000191:economics / Q000627:therapeutic use; D012720:Severity of Illness Index; D015607:Stents / Q000191:economics
chemical_list: C505752:Onyx HD 500; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Aneurysm; Coil; Cost; Pipeline embolization device