{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:40:43Z","timestamp":1785519643656,"version":"3.56.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5]]},"abstract":"\n OBJECTIVE<\/jats:title>\n With the continuous rise of health care costs, hospitals and health care providers must find ways to reduce costs while maintaining high-quality care. Comparing surgical and endovascular treatment of intracranial aneurysms may offer direction in reducing health care costs. The Value-Driven Outcomes (VDO) database at the University of Utah identifies cost drivers and tracks changes over time. In this study, the authors evaluate specific cost drivers for surgical clipping and endovascular management (i.e., coil embolization and flow diversion) of both ruptured and unruptured intracranial aneurysms using the VDO system.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors retrospectively reviewed surgical and endovascular treatment of ruptured and unruptured intracranial aneurysms from July 2011 to January 2017. Total cost (as a percentage of each patient\u2019s cost to the system), subcategory costs, and potential cost drivers were evaluated and analyzed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 514 aneurysms in 469 patients were treated; 273 aneurysms were surgically clipped, 102 were repaired with coiling, and 139 were addressed with flow diverter placements. Middle cerebral artery aneurysms accounted for the largest portion of cases in the clipping group (29.7%), whereas anterior communicating artery aneurysms were most frequently involved in the coiling group (30.4%) and internal carotid artery aneurysms were the majority in the flow diverter group (63.3%). Coiling (mean total cost 0.25% \u00b1 0.20%) had a higher cost than flow diversion (mean 0.20% \u00b1 0.16%) and clipping (mean 0.17 \u00b1 0.14%; p = 0.0001, 1-way ANOVA). Coiling cases cost 1.5 times as much as clipping and flow diversion costs 1.2 times as much as clipping. Facility costs were the most significant contributor to intracranial clipping costs (60.2%), followed by supplies (18.3%). Supplies were the greatest cost contributor to coiling costs (43.2%), followed by facility (40.0%); similarly, supplies were the greatest portion of costs in flow diversion (57.5%), followed by facility (28.5%). Cost differences for aneurysm location, rupture status, American Society of Anesthesiologists (ASA) grade, and discharge disposition could be identified, with variability depending on surgical procedure. A multivariate analysis showed that rupture status, surgical procedure type, ASA status, discharge disposition, and year of surgery all significantly affected cost (p < 0.0001).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Facility utilization and supplies constitute the majority of total costs in aneurysm treatment strategies, but significant variation exists depending on surgical approach, rupture status, and patient discharge disposition. Developing and implementing approaches and protocols to improve resource utilization are important in reducing costs while maintaining high-quality patient care.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2018.1.focus17775","type":"journal-article","created":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T03:36:51Z","timestamp":1525145811000},"page":"E3","source":"Crossref","is-referenced-by-count":33,"title":["Analysis of cerebrovascular aneurysm treatment cost: retrospective cohort comparison of clipping, coiling, and flow diversion"],"prefix":"10.3171","volume":"44","author":[{"given":"Spencer","family":"Twitchell","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussam","family":"Abou-Al-Shaar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Reese","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Karsy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilyas M.","family":"Eli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Taussky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Couldwell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Australas Radiol","first-page":"249","article-title":"Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms","volume":"46","author":"Bairstow P","year":"2002","unstructured":"Bairstow P, Dodgson A, Linto J, Khangure M: Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms. Australas Radiol 46:249\u2013251, 2002"},{"issue":"6","key":"b2","series-title":"Neurosurg Focus","first-page":"E3","article-title":"The present and future of quality measures and public reporting in neurosurgery","volume":"39","author":"Bekelis K","year":"2015","unstructured":"Bekelis K, McGirt MJ, Parker SL, Holland CM, Davies J, Devin CJ, : The present and future of quality measures and public reporting in neurosurgery. Neurosurg Focus 39(6):E3, 2015"},{"key":"b3","series-title":"Neurosurgery","first-page":"944","article-title":"Cost comparison of endovascular treatment of anterior circulation aneurysms with the pipeline embolization device and stent-assisted coiling","volume":"71","author":"Colby GP","year":"2012","unstructured":"Colby GP, Lin LM, Paul AR, Huang J, Tamargo RJ, Coon AL: Cost comparison of endovascular treatment of anterior circulation aneurysms with the pipeline embolization device and stent-assisted coiling. Neurosurgery 71:944\u2013950, 2012"},{"key":"b4","series-title":"Neurosurgery","first-page":"733","article-title":"Cost comparison of surgical and endovascular treatment of unruptured giant intracranial aneurysms","volume":"77","author":"Familiari P","year":"2015","unstructured":"Familiari P, Maldaner N, Kursumovic A, Rath SA, Vajkoczy P, Raco A, : Cost comparison of surgical and endovascular treatment of unruptured giant intracranial aneurysms. Neurosurgery 77:733\u2013743, 2015"},{"key":"b5","series-title":"J Neurosurg","article-title":"Cost of coils for intracranial aneurysms: clinical decision analysis for implementation of a capitation model","author":"Gandhoke GS","unstructured":"Gandhoke GS, Pandya YK, Jadhav AP, Jovin T, Friedlander RM, Smith KJ, : Cost of coils for intracranial aneurysms: clinical decision analysis for implementation of a capitation model. J Neurosurg [epub ahead of print August 25, 2017; DOI: 10.3171\/2017.3.JNS163149], 2017"},{"key":"b6","series-title":"Cerebrovasc Dis","first-page":"40","article-title":"Direct costs of surgical clipping and endovascular coiling of unruptured intracranial aneurysms","volume":"22","author":"Halkes PH","year":"2006","unstructured":"Halkes PH, Wermer MJ, Rinkel GJ, Buskens E: Direct costs of surgical clipping and endovascular coiling of unruptured intracranial aneurysms. Cerebrovasc Dis 22:40\u201345, 2006"},{"key":"b7","series-title":"World Neurosurg","first-page":"818","article-title":"Assessment of cost drivers in transsphenoidal approaches for resection of pituitary tumors using the value-driven outcome database","volume":"105","author":"Karsy M","year":"2017","unstructured":"Karsy M, Brock AA, Guan J, Bisson EF, Couldwell WT: Assessment of cost drivers in transsphenoidal approaches for resection of pituitary tumors using the value-driven outcome database. 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JAMA 316:1061\u20131072, 2016"},{"key":"b12","series-title":"J Neurosurg","first-page":"880","article-title":"Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States","volume":"110","author":"Maud A","year":"2009","unstructured":"Maud A, Lakshminarayan K, Suri MF, Vazquez G, Lanzino G, Qureshi AI: Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States. 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Washington, DC: National Academies Press, 2013"},{"key":"b1","series-title":"Australas Radiol","first-page":"249","article-title":"Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms","volume":"46","author":"Bairstow P","year":"2002","unstructured":"Bairstow P, Dodgson A, Linto J, Khangure M: Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms. Australas Radiol 46:249\u2013251, 2002"},{"issue":"6","key":"b2","series-title":"Neurosurg Focus","first-page":"E3","article-title":"The present and future of quality measures and public reporting in neurosurgery","volume":"39","author":"Bekelis K","year":"2015","unstructured":"Bekelis K, McGirt MJ, Parker SL, Holland CM, Davies J, Devin CJ, : The present and future of quality measures and public reporting in neurosurgery. 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Cerebrovasc Dis 22:40\u201345, 2006"},{"key":"b7","series-title":"World Neurosurg","first-page":"818","article-title":"Assessment of cost drivers in transsphenoidal approaches for resection of pituitary tumors using the value-driven outcome database","volume":"105","author":"Karsy M","year":"2017","unstructured":"Karsy M, Brock AA, Guan J, Bisson EF, Couldwell WT: Assessment of cost drivers in transsphenoidal approaches for resection of pituitary tumors using the value-driven outcome database. World Neurosurg 105:818\u2013823, 2017"},{"key":"b8","series-title":"J Neurosurg","first-page":"1071","article-title":"Reducing costs while maintaining quality in endovascular neurosurgical procedures","volume":"121","author":"Kashlan ON","year":"2014","unstructured":"Kashlan ON, Wilson TJ, Chaudhary N, Gemmete JJ, Stetler WR Jr, Dunnick NR, : Reducing costs while maintaining quality in endovascular neurosurgical procedures. 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J Am Med Inform Assoc 22:223\u2013235, 2015"},{"key":"b10","series-title":"J Korean Neurosurg Soc","first-page":"455","article-title":"Comparative cost analysis for surgical and endovascular treatment of unruptured intracranial aneurysms in South Korea","volume":"57","author":"Kim M","year":"2015","unstructured":"Kim M, Park J, Lee J: Comparative cost analysis for surgical and endovascular treatment of unruptured intracranial aneurysms in South Korea. J Korean Neurosurg Soc 57:455\u2013459, 2015"},{"key":"b11","series-title":"JAMA","first-page":"1061","article-title":"Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality","volume":"316","author":"Lee VS","year":"2016","unstructured":"Lee VS, Kawamoto K, Hess R, Park C, Young J, Hunter C, : Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality. JAMA 316:1061\u20131072, 2016"},{"key":"b12","series-title":"J Neurosurg","first-page":"880","article-title":"Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States","volume":"110","author":"Maud A","year":"2009","unstructured":"Maud A, Lakshminarayan K, Suri MF, Vazquez G, Lanzino G, Qureshi AI: Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States. J Neurosurg 110:880\u2013886, 2009"},{"key":"b13","series-title":"AJNR Am J Neuroradiol","first-page":"935","article-title":"Bioactive versus bare platinum coils in the treatment of intracranial aneurysms: the MAPS (Matrix and Platinum Science) trial","volume":"35","author":"McDougall CG","year":"2014","unstructured":"McDougall CG, Johnston SC, Gholkar A, Barnwell SL, Vazquez Suarez JC, Mass\u00f3 Romero J, : Bioactive versus bare platinum coils in the treatment of intracranial aneurysms: the MAPS (Matrix and Platinum Science) trial. AJNR Am J Neuroradiol 35:935\u2013942, 2014"},{"key":"b14","series-title":"J Clin Neurosci","first-page":"1632","article-title":"Hospitalization cost after spine surgery in the United States of America","volume":"22","author":"Missios S","year":"2015","unstructured":"Missios S, Bekelis K: Hospitalization cost after spine surgery in the United States of America. J Clin Neurosci 22:1632\u20131637, 2015"},{"key":"b15","series-title":"Lancet","first-page":"1267","article-title":"International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial","volume":"360","author":"Molyneux A","year":"2002","unstructured":"Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, : International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. 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