Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms

Abstract

Endovascular techniques for the treatment of intracranial aneurysms have gained rapid acceptance in some countries as an alternative to conventional neurosurgical treatment. The International Subarachnoid Aneurysm Trial (ISAT) is the first multicentre prospective randomized trial comparing neurosurgery with endovascular coil (Guglielmi detachable coil) treatment of acute subarachnoid haemorrhage. The cost and outcome of endovascular procedures was compared with neurosurgical procedures in the treatment of ruptured intracranial aneurysms within the context of the ISAT. Two groups of patients (Endovascular group with 10 patients and the Neurosurgical group with 12 patients) were drawn from admissions to Royal Perth Hospital and Sir Charles Gairdner Hospital, Perth, Western Australia, as detailed in the ISAT trial protocol. Data were collected in the following categories: patient, procedure, hospitalization, morbidity and mortality. While the endovascular procedure tended to be the more expensive in terms of the cost of consumables, this expense was more than compensated by savings in staffing costs, and the period and cost of hospitalization. Following an endovascular procedure, patients tended to return to normal activity or paid employment sooner and have a favourable functional outcome compared with patients following a neurosurgical procedure.