Medicare expenditures for elderly patients undergoing surgical clipping or endovascular intervention for unruptured cerebral aneurysms

Abstract

Background The cost difference between the two treatment options (surgical clipping and endovascular therapy) for unruptured cerebral aneurysms remains an issue of debate. We investigated the association of treatment method for unruptured cerebral aneurysms and Medicare expenditures in elderly patients. Methods We performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients, who underwent treatment for unruptured cerebral aneurysms from 2007 to 2012. In order to control for measured confounding, we used multivariable regression analysis with mixed effects to account for clustering at the HRR level. An instrumental variable (regional rates of endovascular treatment) analysis was used to control for unmeasured confounding by creating pseudo-randomization on the treatment method. Results During the study period, there were 8,705 patients, who underwent treatment for unruptured cerebral aneurysms, and met the inclusion criteria. Of these, 2,585 (29.7%) had surgical clipping, and 6,120 (70.3%) had endovascular treatment. The median total Medicare expenditures in the first year after the admission for the procedure were $46,800 (IQR $31,000 to $74,400) for surgical clipping, and $48,100 (IQR $34,500 to $73,900) for endovascular therapy. When we adjusted for unmeasured confounders, using an instrumental variable analysis, clipping was associated with increased 7-day Medicare expenditures by $3,527 (95% CI, $972 to $5,736) and increased 1-year Medicare expenditures by $15,984 (95% CI, $9,017 to $22,951). Conclusions In a cohort of Medicare patients, after controlling for unmeasured confounding, we demonstrated that surgical clipping of unruptured cerebral aneurysms was associated with increased 1-year expenditures in comparison to endovascular treatment.

Cost‐effectiveness of Screening for Nasopharyngeal Carcinoma among Asian American Men in the United States

“…Incidental findings from additional workup due to a false‐positive screening test could result in additional costs. The cost of care for management of an asymptomatic brain aneurysm was determined from a report of the mean total Medicare spending after surgical clipping or endovascular repair 31 …”

“…The cost of care for management of an asymptomatic brain aneurysm was determined from a report of the mean total Medicare spending after surgical clipping or endovascular repair. 31 All costs were adjusted to 2017 dollars with the Consumer Price Index. 32…”

Three-dimensional aneurysm volume measurements show no correlation between coil packing density and recurrence

“…In a major shift over the last decade, ruptured aneurysms are currently coiled as frequently as they are clipped [ 5 , 6 ]. At the same time, up to 70% of unruptured aneurysms are treated with coiling as the first line therapy [ 7 ].…”