BACKGROUND AND PURPOSE: The International Subarachnoid Aneurysm Trial (ISAT) reported that endovascular coiling yields better clinical outcomes than surgical clipping at 1 year. The high cost of the consumables associated with the endovascular coiling procedure (particularly the coils) led health care purchasers to conclude that coiling was a more costly procedure overall. To examine this assumption and provide evidence for future policy, accurate and comprehensive data are required on the overall resource usage and cost of each strategy. METHODS: We provide detailed results of patient treatment pathways, resource utilization, and costs up to 24 months postrandomization for endovascular and neurosurgical treatment of aSAH. We report data on costs related to initial and subsequent procedures (ward days, ITU, equipment, staff, consumables, etc), adverse events, complications, and follow up. The data are based on a subsample of all patients randomized in ISAT, containing all patients across 22 UK centers (n=1644). RESULTS: There was a nonsignificant difference - pound 1740 (- pound 3582 to pound 32) in the total 12-month cost of treatment in favor of endovascular treatment. Endovascular patients had higher costs than neurosurgical patients for the initial procedure, for the number and length of stay of subsequent procedures, and for follow-up angiograms. These were more than offset by lower costs related to length of stay for the initial procedure. In the following 12- to 24-month period, costs for subsequent procedures, angiograms, complications, and adverse events were greater for the endovascular patients, reducing the difference in total per patient cost to - pound 1228 (- pound 3199 to pound 786) over the first 24 months of follow-up. CONCLUSIONS: No significant difference in costs between the endovascular and neurosurgery groups existed at 12- or 24-month follow up.
RCT Entities:
BACKGROUND AND PURPOSE: The International Subarachnoid Aneurysm Trial (ISAT) reported that endovascular coiling yields better clinical outcomes than surgical clipping at 1 year. The high cost of the consumables associated with the endovascular coiling procedure (particularly the coils) led health care purchasers to conclude that coiling was a more costly procedure overall. To examine this assumption and provide evidence for future policy, accurate and comprehensive data are required on the overall resource usage and cost of each strategy. METHODS: We provide detailed results of patient treatment pathways, resource utilization, and costs up to 24 months postrandomization for endovascular and neurosurgical treatment of aSAH. We report data on costs related to initial and subsequent procedures (ward days, ITU, equipment, staff, consumables, etc), adverse events, complications, and follow up. The data are based on a subsample of all patients randomized in ISAT, containing all patients across 22 UK centers (n=1644). RESULTS: There was a nonsignificant difference - pound 1740 (- pound 3582 to pound 32) in the total 12-month cost of treatment in favor of endovascular treatment. Endovascular patients had higher costs than neurosurgical patients for the initial procedure, for the number and length of stay of subsequent procedures, and for follow-up angiograms. These were more than offset by lower costs related to length of stay for the initial procedure. In the following 12- to 24-month period, costs for subsequent procedures, angiograms, complications, and adverse events were greater for the endovascular patients, reducing the difference in total per patient cost to - pound 1228 (- pound 3199 to pound 786) over the first 24 months of follow-up. CONCLUSIONS: No significant difference in costs between the endovascular and neurosurgery groups existed at 12- or 24-month follow up.
Authors: Volker Seifert; Rüdiger Gerlach; Andreas Raabe; Erdem Güresir; Jürgen Beck; Andrea Szelényi; Matthias Setzer; Hartmut Vatter; Richard Du Mesnil de Rochemont; Friedhelm Zanella; Matthias Sitzer; Joachim Berkefeld Journal: Dtsch Arztebl Int Date: 2008-06-20 Impact factor: 5.594
Authors: Kimon Bekelis; Daniel J Gottlieb; Yin Su; Giuseppe Lanzino; Michael T Lawton; Todd A MacKenzie Journal: J Neurosurg Date: 2016-05-20 Impact factor: 5.115
Authors: Oliver Rivero-Arias; Jane Wolstenholme; Alastair Gray; Andrew J Molyneux; Richard S C Kerr; Julia A Yarnold; Mary Sneade Journal: J Neurol Date: 2009-02-09 Impact factor: 4.849