title: Reducing costs while maintaining quality in endovascular neurosurgical procedures.
abstract: OBJECTIVE
  As medical costs continue to rise during a time of increasing medical resource utilization, both hospitals and physicians must attempt to limit superfluous health care expenses. Neurointerventional treatment has been shown to be costly, but it is often the best treatment available for certain neuropathologies. The authors studied the effects of 3 policy changes designed to limit the costs of performing neurointerventional procedures at the University of Michigan.
  
  
  METHODS
  The authors retrospectively analyzed the costs of performing neurointerventional procedures during the 6-month periods before and after the implementation of 3 cost-saving policies: 1) the use of an alternative, more economical contrast agent, 2) standardization of coil prices through negotiation with industry representatives to receive economies of scale, and 3) institution of a feedback method to show practitioners the costs of unused products per patient procedure. The costs during the 6-month time intervals before and after implementation were also compared with costs during the most recent 6-month time period.
  
  
  RESULTS
  The policy requiring use of a more economical contrast agent led to a decrease in the cost of contrast usage of $42.79 per procedure for the first 6 months after implementation, and $137.09 per procedure for the most current 6-month period, resulting in an estimated total savings of $62,924.31 for the most recent 6-month period. The standardized coil pricing system led to savings of $159.21 per coil after the policy change, and $188.07 per coil in the most recent 6-month period. This yielded total estimated savings of $76,732.56 during the most recent 6-month period. The feedback system for unused items decreased the cost of wasted products by approximately $44.36 per procedure in the 6 months directly after the policy change and by $48.20 per procedure in the most recent 6-month period, leading to total estimated savings of $22,123.80 during the most recent 6-month period. According to extrapolation over a 1-year period, the 3 policy changes decreased costs by an estimated $323,561.34.
  
  
  CONCLUSIONS
  Simple cost-saving policies can lead to substantial reductions in costs of neurointerventional procedures while maintaining high levels of quality and growth of services.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Osama N
authors.initials: ON
authors.lastname: Kashlan
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.forename: William R
authors.initials: WR
authors.lastname: Stetler
authors.forename: N Reed
authors.initials: NR
authors.lastname: Dunnick
authors.forename: B Gregory
authors.initials: BG
authors.lastname: Thompson
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
mesh_terms: D003132:Commerce; D003287:Contrast Media / Q000191:economics; D003363:Cost Control / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000191:economics* / Q000379:methods / Q000592:standards; D004864:Equipment and Supplies; D006801:Humans; D019635:Neurosurgical Procedures / Q000191:economics* / Q000379:methods / Q000592:standards; D057766:Policy; D011787:Quality of Health Care; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000191:economics
chemical_list: D003287:Contrast Media
keywords: contrast media; cost reduction measures; endovascular coils; endovascular procedures; inventory control; neurointerventional procedures; vascular disorders