{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:40:37Z","timestamp":1768567237398,"version":"3.49.0"},"reference-count":22,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2019,4,28]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Endovascular treatment of basilar tip aneurysms is less invasive than microsurgical clipping, but requires closer follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To characterize the additional costs associated with endovascular treatment of basilar tip aneurysms rather than microsurgical clipping.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and methods<\/jats:title>\n                  <jats:p>We obtained clinical records and billing information for 141 basilar tip aneurysms treated with clip ligation (n=48) or endovascular embolization (n=93). Costs included direct and indirect costs associated with index hospitalization, as well as re-treatments, follow-up visits, imaging studies, rehabilitation, and disability. Effectiveness of treatment was quantified by converting functional outcomes (modified Rankin Scale (mRS) score) into quality-adjusted life-years (QALYs). Cost-effectiveness was performed using cost\/QALY ratios.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Average index hospitalization costs were significantly higher for patients with unruptured aneurysms treated with clip ligation ($71 400 \u00b1 $47 100) compared with coil embolization ($33 500 \u00b1 $22 600), balloon-assisted coiling ($26 200 \u00b1 $11 600), and stent-assisted coiling ($38 500 \u00b1 $20 900). Multivariate predictors for higher index hospitalization cost included vasospasm requiring endovascular intervention, placement of a ventriculoperitoneal shunt, longer length of stay, larger aneurysm neck and width, higher Hunt-Hess grade, and treatment-associated complications. At 1\u2009year, endovascular treatment was associated with lower cost\/QALY than clip ligation in unruptured aneurysms ($52 000\/QALY vs $137 000\/QALY, respectively, p=0.006), but comparable rates in ruptured aneurysms ($193 000\/QALY vs $233 000\/QALY, p=0.277). Multivariate predictors for higher cost\/QALY included worse mRS score at discharge, procedural complications, and larger aneurysm width.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Coil embolization of basilar tip aneurysms is associated with a lower cost\/QALY. This effect is sustained during follow-up. Clinical condition at discharge is the most significant predictor of overall cost\/QALY at 1\u2009year.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/neurintsurg-2019-014747","type":"journal-article","created":{"date-parts":[[2019,6,25]],"date-time":"2019-06-25T17:26:14Z","timestamp":1561483574000},"page":"1210-1215","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical outcomes and cost-effectiveness analysis for the treatment of basilar tip aneurysms"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8995-4657","authenticated-orcid":false,"given":"Isaac Josh","family":"Abecassis","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev","family":"Sen","sequence":"additional","affiliation":[{"name":"Department of Neurological 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