title: [Endovascular versus surgical treatment in subarachnoid haemorrhage: Cost analysis].
abstract: OBJECTIVE
  To analyse costs of endovascular versus surgical treatment in 80 patients with aneurysmal subarachnoid haemorrhage (aSAH).
  
  
  METHODS
  We analysed data on 80 consecutive patients with aSAH between January 2010 and June 2011. Endovascular treatment was used in 57 patients and surgical in 23 patients. Demographic (gender and age) and clinical data (Hunt-Hess and Fisher scales), length of stay (ICU and ward) and results at 6 months (Glasgow outcome scale,[GOS]) were collected. Costs including stay, follow-up, complications and retreatments were calculated.
  
  
  RESULTS
  Age was higher in the endovascular group (statistically significant). There were no differences between the 2 groups in Hunt-Hess and Fisher scales. Results at 6 months were also similar, although slightly better in the surgical group. Length of stay was longer in surgical patients, both in ICU (mean 1.4 days) and ward (1.7 days). Hospitalisation length was also related to age and Hunt-Hess and Fisher scales. Costs from embolisation devices, follow-up and retreatment (12% in this series) made final endovascular treatment 4.1% more expensive than surgical treatment (€35,835 versus €34,404). Endovascular procedure (including retreatments) was 110% more expensive than surgical treatment (€8,015 versus €3,817).
  
  
  CONCLUSIONS
  There are no differences between the 2 treatments in terms of morbidity and mortality. Stability of surgical treatment was higher than that of endovascular, with better occlusion and lower retreatment rates. Endovascular treatment is more expensive in ruptured aneurysms, principally due to embolisation device costs, long-term follow-up and retreatments, in retreatments, in spite of shorter hospital stay. In incidental aneurysms, which usually need shorter hospitalisation, differences between the 2 treatments could be even larger.
authors.affiliation: Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España. Electronic address: angel.horcajadas@gmail.com.
authors.forename: Angel
authors.initials: A
authors.lastname: Horcajadas Almansa
authors.affiliation: Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España.
authors.forename: Majed
authors.initials: M
authors.lastname: Jouma Katati
authors.affiliation: Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Román Cutillas
authors.affiliation: Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Jorques Infante
authors.affiliation: Servicio de Neurocirugía, Hospital Neurotraumatológico. Jaén, España.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Cordero Tous
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D057510:Endovascular Procedures / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000191:economics; D055815:Young Adult
keywords: Aneurisma cerebral; Brain aneurysm; Coil; Costes; Costs; Embolisation; Embolización; Hemorragia subaracnoidea; Subarachnoid haemorrhage