Johns Hopkins Health Alert
Aneurysms: To Clip or To Coil?
Do the benefits of a relatively new way to repair ruptured brain aneurysms outweigh the high cost of the procedure? A new study reported in the Journal of Neurosurgery (volume 110, page 880) suggests that the answer may be yes.
Coiling is a minimally invasive technique in which doctors place a platinum coil into the ruptured aneurysm via a catheter inserted through a small incision in the groin. Clipping, the standard procedure, involves open surgery to repair the aneurysm.
Researchers compared the rates of death and disability and the costs of hospitalization, disability, and follow-up care and treatment in approximately 1,000 aneurysm patients who underwent coiling and a similar number treated with clipping.
At the one-year mark, aneurysm patients who underwent the coiling procedure had lower rates of disability and death than those in the clipping group. During that time, the total cost of the coiling procedure was higher ($45,000 versus $42,000), mostly because patients needed more follow-up brain angiograms and treatment. However, when the researchers calculated the cost per each year of survival gained, a measure of cost effectiveness, it was the same for both groups -- $65,000.
Because follow-up angiograms and additional treatment occur most often in the first year, the cost-effectiveness of coiling may eclipse that of clipping over the long term. But the long-term recurrence rate of aneurysms treated with coiling is still unknown.
Posted in Hypertension and Stroke on June 22, 2010
Reviewed January 2011
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