1047. Clipping vs. Coiling for Aneurysmal Subarachnoid Hemorrhage (aSAH): A Real-World Health Economic Analysis across the US Population:
Authors: Robert M. Gramer; Robert Gramer, BS; Harrison Farber, MD; Beiyu Liu, PhD; Syed Adil; Lefko Charalambous; Musa Kiyani; Beth Parente, PA; Ali Zomorodi; Fernando Gonzalez; Erik Hauck; Shivanand Lad (Toronto, Canada)
Introduction Two main treatments are used for patients with ruptured intracranial aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. Several clinical trials over the last two decades have examined these treatments in patients with aneurysmal Subarachnoid Hemorrhage (aSAH) with various sample sizes: ISAT (n=2143), BRAT (n=408), PUFS (n=108). Still, little is known regarding the real-world health economics of these procedures at the population level. Methods Querying the Truven MarketScan ® Database, 8108 adult patients who were diagnosed with aSAH had either clipping or coiling procedures between 2008 to 2015. A total of 3807 had 12-months of continuous pre-aSAH enrollment, and were included in the analyses. For health care resource utilization (HCRU) analysis, only patients with continuous enrollment were included, resulting in a total of 2374 patients that met inclusion criteria. Results Age, gender, geographical location, insurance type, and Charlson Comorbidity Index (CCI) were similar between treatment groups. 974 (25.6%) received clipping and 2833 (74.4%) received coiling and there was no significant difference in the one-year survival rate (90.5% for clipping and 89.6% for coiling; p-value =0.4651). The median cost in the first 90-days post-aSAH for patients was $151,321 (clipping) and $139,834 (coiling). The total cost decreased after 90 days, with a median cost of $6,575 (clipping) and $13,981 (coiling) during the 90-day to 1-year period after the initial diagnosis. The five-year cumulative cost was $166,333 and $167,874 for clipping and coiling, respectively. Conclusions In patients with a ruptured intracranial aneurysm, the outcomes of endovascular coiling and neurosurgical clipping in terms of survival and cost appear to be similar at 1 and 5 years in a broad US population. With the advent of new endovascular and neurointerventional therapies for aSAH, the short and long-term outcomes as well as the economic impact of these therapies will be important to assess.