Cost Analysis of Endovascular Coiling and Surgical Clipping for the Treatment of Ruptured Intracranial Aneurysms Daniel Monsivais 1 , Miriam Morales 1 , Arthur Day 1 , Dong Kim 1 , Brian Hoh 2 , Spiros Blackburn 1 - BACKGROUND: Cost-effectiveness analyses for the treatment of aneurysmal subarachnoid hemorrhage are necessary to determine health policy, treatment guidelines, and screening protocols for cerebral aneurysms. To perform these modeling studies, detailed cost data are necessary and are currently lacking. - OBJECTIVE: The goal of this study was to determine detailed inpatient cost of aneurysmal subarachnoid hemorrhage. - METHODS: A retrospective review of our ruptured sub- arachnoid hemorrhage database was performed to identify consecutive patients between January 2013 and December 2015. Patients were searched by International Classification of Disease 9 diagnosis and procedure codes. Patient de- mographics and clinical characteristics were acquired. The cost breakdown was compiled into a comprehensive item- ized list encompassing all aspects of hospitalization. A mean cost based on resource used per patient was obtained. - RESULTS: There were 269 patients treated, 209 were coiled and 60 were clipped. Mean age in the clipping group was 49 years and 55 years in the coil group (P [ 0.006). Other patient demographics and clinical characteristics were found to be statistically similar for both groups. Total cost per patient for treatment and hospital stay was $74,192 for clipping and $85,553 for coiling (P [ 0.06). Cost amplified with increasing Hunt and Hess grade in both clipping and coiling groups. - CONCLUSIONS: The detailed cost information reported in this article can be used to help establish appropriate, standardized costs nationally by improving transparency. It can also help provide critical information necessary to develop cost-effective treatment algorithms and screening protocols. INTRODUCTION S ubarachnoid hemorrhage (SAH) owing to ruptured cerebral aneurysms is associated with significant morbidity, mor- tality, and economic burden. There are approximately 30,000 cases occurring annually in the United States. 1 Sixty percent of those cases are either fatal or the patient is left severely disabled, and the associated yearly economic burden is $1.75 billion. 2 A cost-effective analysis (CEA) describes and contrasts costs and outcomes for the course of events that are expected to occur with a specific intervention, and the expected course of events without the intervention. 3 Such studies are important as they help determine guidelines for treatment and preventative care. To better understand the cost impact of SAH on society and perform these analyses, detailed cost data are necessary. To date, there is 1 large scale study examining treatment for SAH patients in the United States, and this was published prior to widespread use of endovascular management of cerebral aneurysms. 4 Although there are recent U.S. data on hospital charges and relative costs associated with treating patients with SAH, no Key words - Cost-effective analysis - Endovascular coil - Intracranial aneurysm - Neurosurgical clipping - Quality adjusted life years - Subarachnoid hemorrhage Abbreviations and Acronyms CEA: Cost-effective analysis GOSE: Extended Glasgow Outcome Score HH: Hunt and Hess ISAT : International Subarachnoid Aneurysm Trial LOS: Length of stay OR: Operating room SAH: Subarachnoid hemorrhage From the 1 Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas; and 2 Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA To whom correspondence should be addressed: Daniel Monsivais, M.D. [E-mail: Daniel.R.Monsivais@uth.tmc.edu] Citation: World Neurosurg. (2019). https://doi.org/10.1016/j.wneu.2018.12.028 Journal homepage: www.journals.elsevier.com/world-neurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY -: e1-e6, - 2019 www.journals.elsevier.com/world-neurosurgery e1 Original Article