Background and Purpose— Aneurysmal subarachnoid hemorrhage (aSAH) has a high healthcare cost burden. Methods— We performed a cross-sectional analysis of the costs of clipping and coiling of aSAH using the National Inpatient Sample and Vizient databases. We conducted multiple regression analyses to estimate national costs and study associations between patient demographic, clinical, and hospital factors and treatment costs. Results— We identified 23 324 ruptured aneurysm patients in the National Inpatient Sample (2002–2013) and found mean inflation-adjusted costs for clipping increased 41.0% ($66 358±1354–$93 597±2339), whereas costs for coiling increased 38.9% ($62 972±2657–$87 441±2382). Multivariate analysis showed that age, length of stay, insurance, comorbidities, risk of mortality, and urban teaching hospital status were associated with higher hospital costs for clipping and coiling (all P <0.05). In the Vizient database (2013–2015), costs for clipping and coiling increased 11% and 5%, respectively. Both databases demonstrated that the western United States had the highest health expenditures for aSAH ( P <0.05). Conclusions— Findings show substantial cost increases and regional cost disparities for aSAH treatments. Patient and hospital factors copredict higher costs for aSAH procedures. Interhospital and regional cost variations open the door for cost-containment strategic development.

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BACKGROUND Neurosurgical spine specialists receive considerable amounts of industry support which may impact the cost of care. The aim of this study was to evaluate the association between industry payments received by spine surgeons and the total hospital and operating room (OR) costs of an anterior cervical discectomy and fusion (ACDF) procedure among Medicare beneficiaries. METHODS All ACDF cases were identified among the Medicare Carrier Files, from January 1, 2013, to December 31, 2014, and matched to the Medicare Inpatient Baseline File. The total hospital and OR charges were obtained for these cases. Charges were converted to cost using year-specific cost-to-charge ratios. Surgeons were identified among Open Payments database, which is used to quantify industry support. Analyses was performed to examine the association between industry payments received and ACDF costs. RESULTS Matching resulting in the inclusion of 2,209 ACDF claims from 2013-2014. In 2013 and 2014, the mean total cost for an ACDF was 21, 798and21,008, respectively; mean OR cost was 5, 878and6,064, respectively. Mann-Whitney U test demonstrated no significant differences in the mean total or OR cost for an ACDF based on quartile of general industry payment received (p=0.21 and p=0.54), and linear regression found no association between industry general payments, research support, or investments on the total hospital cost (p=0.41, p=0.13, and p=0.25), or OR cost for an ACDF (p=0.35, p=0.24, and p=0.40). CONCLUSIONS This study suggests that spine surgeons performing ACDF surgeries may receive industry support without impacting the cost of care.

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