Comparative cost analysis of endovascular and open approaches for elective treatment of middle cerebral artery aneurysms

被引:0
作者
Lauzier, David C. [1 ,2 ]
Cler, Samuel J. [1 ,2 ]
Srienc, Anja, I [1 ,2 ]
Patel, Bhuvic [1 ]
Pierce, Andrew [3 ]
Gagne, Jason [3 ]
Vellimana, Ananth K. [1 ,2 ,4 ]
Chatterjee, Arindam R. [1 ,2 ,4 ]
Kansagra, Akash P. [5 ]
Moran, Christopher J. [1 ,2 ]
Zipfel, Gregory J. [1 ,4 ]
Osbun, Joshua W. [1 ,2 ,4 ]
机构
[1] Washington Univ, Sch Med, Dept Neurol Surg, St Louis, MO 63130 USA
[2] Washington Univ, Mallinckrodt Inst Radiol, Sch Med, St Louis, MO 63130 USA
[3] Barnes Jewish Hosp Clin Operat, St Louis, MO USA
[4] Washington Univ, Sch Med, Dept Neurol, St Louis, MO USA
[5] Calif Ctr Neurointervent Surg, Dept Neurointervent Surg, St Louis, MO USA
关键词
Aneurysm; endovascular; craniotomy; pterional; lateral supraorbital; INTRACRANIAL ANEURYSMS; COILING;
D O I
10.1177/15910199231221298
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Intracranial aneurysms of the middle cerebral artery can be treated using several open surgical and endovascular approaches. Given the growing evidence of clinical equipoise between these various treatment strategies, there is a need to assess the costs associated with each. Methods: Cost of aneurysm treatment was divided into two categories for comparison. "Initial cost" comprised the total in-hospital expenses for initial aneurysm treatment and "total cost" comprised initial aneurysm treatment and all expenses relating to readmission due to treatment-related complications, prescribed catheter angiograms for monitoring of treatment stability, and any retreatments needed for a given aneurysm. The open surgical group was subdivided into a pterional approach group and a lateral supraorbital (LSO) approach group for. Results: Median initial cost was $37,152 (IQR $31,318-$44,947) for aneurysms treated with the pterional approach, $29,452 (IQR $27,779-$32,826) for aneurysms treated with the LSO approach, and $19,587 (IQR $14,125-$30,521) for aneurysms treated with endovascular approaches. The median total cost was $39,737 (IQR $33,891-$62,259) for aneurysms treated with the pterional approach, $31,785 (IQR $29,513-$41,099) for aneurysms treated with the LSO approach, and $24,578 (IQR $18,977-$34,547) for aneurysms treated with endovascular approaches. Analysis of variance test demonstrated variance across groups for both initial and total cost (p = 0.004, p = 0.008, respectively). In our subsequent analysis, initial cost and total cost were higher in the pterional group than the endovascular group (p = 0.003 and p = 0.006, respectively). Conclusions: Endovascular treatment of elective aneurysms has a significantly lower cost than open surgical treatment with the pterional approach, but not with the LSO approach. For aneurysms not amenable to endovascular treatment, a minimally invasive LSO approach carries a lower cost burden than a pterional approach.
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