Medico-financial Environment on Treatment for Acutely Ruptured Cerebral Aneurysms. GDC Embolization vs Neck Clipping

Abstract

We have been using the Guglielmi detachable coils (GDC) since 1997 as one choice of cerebral aneurysm treatment.We have, at the present time, two effective radical treatment methods for acutely ruptured cerebral aneurysms, GDC embolization and conventional surgical aneurysmal neck clipping. There ensued questions about the cost and efficacy of the two strategies. Retrospective analysis was done on a GDC group and a clipping group, with each twenty consecutive patients. The features of the GDC group patients were higher age, and poorer Hunt and Kosnik grades than the other group. All MCA aneurysms were treated with surgical neck clipping, while all the posterior circulation aneurysms were embolized with GDC. Based on the Japanese Medical Insurance and Payment System, 477,890 points (1 point = yen 10) as a mean was required with the GDC group, and 456,084 points with the neck clipping group, showing no significant difference between the two groups. In the GDC group, the cost of the implanted medical device seemed to raise the total medical expense. At present, the GDC embolization is the preferred choice of strategies in acutely ruptured cerebral aneurysms, and its preference increases in the surgically difficult cases, very old, or poor grade patients, and in various complicated cases. And, the GDC embolization seems to be satisfactory from the medico-financial viewpoint.

Figure 1

Patients' clinical back ground; Hunt and Kosnik grade. The GDC group included poor-grade patients (nine of twenty, 45%).

Figure 2

Patients' clinical background; Locations of ruptured cerebral aneurysms and Hunt and Kosnik grades. All posterior circulation aneurysms were treated with GDC. All middle cerebral artery aneurysms were treated by surgical neck clipping. The other cerebral aneurysms were treated by one of two methods because of age, severity, medical conditions, and other reasons.

Figure 3

Medical expenses based on the Japanese medical insurance and payment system. There was no significant difference between the two groups in the total medical expenses. In the GDC group, the cost of medical devices was marked. The technical fees of procedures were more expensive in the clipping group.

Figure 4

Correlations between the medical expenses and the Hunt and Kosnik grades. The total medical expenses increased proportionally with the severity of the condition of patients. But, those of the GDC group increased more gradually than those of the clipping

Figure 5

Hospitalized days. The GDC group was better than the clipping group in any grade of Hunt and Kosnik grade.