Hospitalization Costs for Endovascular and Surgical Treatment of Ruptured Aneurysms in the United States Are Substantially Higher Than Medicare Payments

BACKGROUND AND PURPOSE: Endovascular and surgical options are both available for treatment of ruptured cerebral aneurysms. Knowledge of the costs relative to Medicare reimbursement for hospitalization of these patients is important for understanding the economic impact of these patients on hospitals. MATERIALS AND METHODS: Using the NIS, we identified hospitalizations for clipping and coiling of ruptured cerebral aneurysms from 2001 to 2008 by cross-matching ICD-9 codes for diagnosis of ruptured aneurysm with procedure codes for clipping or coiling of cerebral aneurysms. Hospital costs for 2008 were correlated with age, sex, and discharge status. For discharges of Medicare patients, we compared Medicare payments with costs for respective MS-DRG. RESULTS: For 2008, the average Medicare payment for craniotomy and endovascular intracranial procedures without complication (MS-DRG 22) was $30,380. Medicare discharges with DRG 22, for patients undergoing clipping had median costs of $59,799 in 2008. Those undergoing coiling had median costs of $36,543. Reimbursement for discharges with complications or comorbidities (MS-DRG 21) was $36,304. Median costs for hospitalization of clipped patients with MS DRG 21 was $79,916 and for coiled patients, $56,910. Reimbursement for MS-DRG 20 (major complications or comorbidities) was $41,748, with patients undergoing clipping incurring a median cost of $83,737 and those undergoing coiling incurring a median cost of $83,277. CONCLUSIONS: Hospitalization costs for patients undergoing clipping and coiling of unruptured cerebral aneurysms are substantially higher than Medicare payments.