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Published in: Acta Neurochirurgica 1/2020

01-01-2020 | Intracranial Aneurysm | Original Article - Vascular Neurosurgery - Aneurysm

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

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

Published in: Acta Neurochirurgica | Issue 1/2020

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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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Metadata
Title
Evaluation of disease severity and treatment intensity as cost drivers for ruptured intracranial aneurysms
Authors
Herschel Wilde
Spencer Twitchell
Jared Reese
Jian Guan
Ilyas M. Eli
Michael Karsy
Philipp Taussky
Ramesh Grandhi
Richard H. Schmidt
William T. Couldwell
Publication date
01-01-2020
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 1/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-019-04153-3

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