If flow-diverters are to become the preferred mode of treating aneurysms then other than their efficacy, an analysis of their financial impact against coiling is warranted.Methodology
An IRB approved retrospective analysis was performed on 500 aneurysms treated in 427 patients. The implant-cost was calculated based on the number and type of coils that were deployed, coils that were opened but not deployed, and use of any adjunctive devices. Total aneurysm-cost included all re-treatments. The aneurysms were divided into < 6 mm, 6–11 mm and >11 mm-groups. Aneurysm-costs were compared with the hospital's cost for a flow-diverter (PipelineTM-$12,500). An analysis was performed to determine a cost-point based on aneurysm size, and use of adjunctive devices at which a flow-diverter became economically superior to coiling. This analysis was repeated for a hypothetically reduced price of the flow-diverter.Results
The total implant-cost per case was $11,447(±$7523). The number of coils had a strong, positive correlation with the implant-cost (R20.8, p < 0.0001). The implant-cost was $9711(±$5868) in ruptured and $12421(±$8135) in unruptured aneurysms (p < 0.0001). Aneurysm size and the use of adjunctive devices had a significant impact on implant-cost (Table 1). In Figure 1, the aneurysm-cost by aneurysm-size and treatment-type is shown with a superimposed cost of PipelineTM(red line). The use of adjunctive devices did not significantly impact the implant cost in aneurysm >11 mm but was significant in the other groups. The use of flow-diverter was economically better than coils in all aneurysms >11 mm, in all aneurysms between 6–11 mm that required an adjunctive device and in all aneurysms < 6mm that required a stent. Lowering the flow-diverter cost to $10,000 (blue-line) shows that most aneurysms above 6mm were economically viable for flow-diversion as opposed to coiling.Conclusion
The implant-cost is affected by number of coils, aneurysm-size and treatment type. A flow-diverter may be economically feasible in aneurysms >11 m, aneurysms between 6–11 mm that require an adjunctive device and aneurysms < 6 mm that require a stent. Lowering the price of a flow-diverter by $2500 magnifies this effect. As the use of flow diverters increases and more devices are available, a price adjustment will make this a very attractive first line treatment.Disclosures
A. Rai: 2; C; Stryker Neurovascular, Codman Neuro. B. Cline: None. A. Tarabishy: None. J. Patterson: None. S. Boo: None. J. Carpenter: None.