Cost-Effectiveness Analysis of Endovascular Coiling versus Neurosurgical Clipping for Intracranial Aneurysms in Republic of Korea.
OBJECTIVE
The International Subarachnoid Aneurysm Trial (ISAT) revealed that in ruptured intracranial aneurysms (RA), endovascular coiling (EC) yields better clinical outcomes than neurosurgical clipping (NC) at 1 year. In unruptured aneurysms (UIA), EC is being increasingly used as an alternative to NC due to patients' preference. There is a lot of difference in treatment cost (EC vs. NC) between countries. There is one recently published study dealing with the comparative cost analysis only in UIAs in South Korea. But it is a hospital-based study. So, the authors performed a nation-wide cost effective comparison in our country.


METHODS
This study was a retrospective analysis of healthcare big data open systems in Health Insurance Review & Assessment Service (HIRA). Hospital cost data of the recent 5 years (from January 2010 to December 2014) were analyzed according to patients' age and sex and the presence of subarachnoid hemorrhage.


RESULTS
When comparing the total hospital costs for NC of a UIA (n=13,756) and EC of a UIA (n=17,666), NC [mean±standard deviation (SD): ￦7,987,179±3,855,029] resulted in significantly lower total hospital costs than EC [￦10,201,645±5,001,626, p<0.0001], although a shorter hospital stay with EC of a UIA [8.6 ±7.4 days] vs. NC [15.0 ±8.3 days, p<0.0001]. When comparing the total hospital costs for NC of a RA (n=7,293) and EC of a RA (n=6,954), NC [￦13,914,993±6,247,914] resulted in significantly lower total hospital costs than EC [￦16,702,446±7,841,141, p<0.0001], although shorter hospital stays for EC of a RA [19.8 ±11.4] vs. NC [23.0 ±10.3, p<0.0001].


CONCLUSIONS
The total hospital costs for the NC of both UIAs and RAs were found to be lower than those for EC in South Korea.
Department of Radiology, Keimyung University, School of Medicine & Dongsan Medical Center, Daegu, Korea.
Hyuk Won
HW
Chang
Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea.
Shang Hun
SH
Shin
Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Sang Hyun
SH
Suh
Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Bum-Soo
BS
Kim
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea.
Myung Ho
MH
Rho
Health, Surgical Instruments; Hospital Costs; Insurance; Intracranial Aneurysm; Retrospective Studies; Subarachnoid Hemorrhage