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Evaluation of disease severity and treatment intensity as cost drivers for ruptured intracranial aneurysms

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Previous studies have not evaluated the impact of illness severity and postrupture procedures in the cost of care for intracranial aneurysms. We hypothesize that the severity of aneurysm rupture and the aggressiveness of postrupture interventions play a role in cost.

Methods

The Value Driven Outcomes database was used to assess direct patient cost during the treatment of ruptured intracranial aneurysm with clipping, coiling, and Pipeline flow diverters.

Results

One hundred ninety-eight patients (mean age 52.8 ± 14.1 years; 40.0% male) underwent craniotomy (64.6%), coiling (26.7%), or flow diversion (8.6%). Coiling was 1.4× more expensive than clipping (p = .005) and flow diversion was 1.7× more expensive than clipping (p < .001). More severe illness as measured by American Society of Anesthesia, Hunt/Hess, and Fisher scales incurred higher costs than less severe illness (p < .05). Use of a lumbar drain protocol to reduce subarachnoid hemorrhage and use of an external ventricular drain to manage intracranial pressure were associated with reduced (p = .05) and increased (p < .001) total costs, respectively. Patients with severe vasospasm (p < .005), those that received shunts (p < .001), and those who had complications (p < .001) had higher costs. Multivariate analysis showed that procedure type, length of stay, number of angiograms, vasospasm severity, disposition, and year of treatment were independent predictors of cost.

Conclusions

These results show for the first time that disease and vasospasm severity and intensity of treatment directly impact the cost of care for patients with aneurysms in the USA. Strategies to alter these variables may prove important for cost reduction.

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Abbreviations

NIS:

National Inpatient Sample

VDO:

Value Driven Outcome

ASA:

American Society of Anesthesiologists

LOS:

Length of stay

EVD:

External ventricular drain

SAH:

Subarachnoid hemorrhage

PCA:

Posterior cerebral artery

SCA:

Superior cerebellar artery

PICA:

Posterior inferior cerebellar artery

AICA:

Anterior inferior cerebellar artery

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Acknowledgments

We thank Kristin Kraus for editorial assistance and Jacob Kresser for assistance with the VDO database.

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Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA

    Herschel Wilde, Spencer Twitchell, Jared Reese, Jian Guan, Ilyas M. Eli, Michael Karsy, Philipp Taussky, Ramesh Grandhi, Richard H. Schmidt & William T. Couldwell

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  1. Herschel Wilde
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  2. Spencer Twitchell
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Correspondence to William T. Couldwell.

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Conflict of interest

Dr. Taussky is a consultant for Medtronic, Stryker Neurovascular, and Cerenovus. Dr. Grandhi is a consultant for Medtronic Neurovascular, Cerenovus, and BALT Neurovascular. The other authors report no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Wilde, H., Twitchell, S., Reese, J. et al. Evaluation of disease severity and treatment intensity as cost drivers for ruptured intracranial aneurysms. Acta Neurochir 162, 157–167 (2020). https://doi.org/10.1007/s00701-019-04153-3

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  • DOI: https://doi.org/10.1007/s00701-019-04153-3

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