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. 2016 Mar;8(3):316-22.
doi: 10.1136/neurintsurg-2014-011575. Epub 2015 Jan 12.

A predictive model of hospitalization cost after cerebral aneurysm clipping

Kimon Bekelis  1 , Symeon Missios  2 , Todd A MacKenzie  3 , Nicos Labropoulos  4 , David W Roberts  5
Affiliations

A predictive model of hospitalization cost after cerebral aneurysm clipping

Kimon Bekelis et al. J Neurointerv Surg. 2016 Mar.

Abstract

Background: Cost containment is the cornerstone of the Affordable Care Act. Although studies have compared the cost of cerebral aneurysm clipping (CAC) and coiling, they have not focused on identification of drivers of cost after CAC, or prediction of its magnitude. The objective of the present study was to develop and validate a predictive model of hospitalization cost after CAC.

Methods: We performed a retrospective study involving CAC patients who were registered in the Nationwide Inpatient Sample (NIS) database from 2005 to 2010. The two cohorts of ruptured and unruptured aneurysms underwent 1:1 randomization to create derivation and validation subsamples. Regression techniques were used for the creation of a parsimonious predictive model.

Results: Of the 7798 patients undergoing CAC, 4505 (58%) presented with unruptured and 3293 (42%) with ruptured aneurysms. Median hospitalization cost was US$24,398 (IQR $17,079 to $38,249) and $73,694 (IQR $46,270 to $115,128) for the two cohorts, respectively. Common drivers of cost identified in the multivariate analyses included the following: length of stay, number of admission diagnoses and procedures, hospital size and region, and patient income. The models were validated in independent cohorts and demonstrated final R(2) values very similar to the initial models. The predicted and observed values in the validation cohort demonstrated good correlation.

Conclusions: This national study identified significant drivers of hospitalization cost after CAC. The presented model can be utilized as an adjunct in the cost containment debate and the creation of data driven policies.

Keywords: Aneurysm; Economics; Intervention; Subarachnoid.

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Conflict of interest statement

Statement: “There are no competing interests”

Figures

Figure 1
Figure 1
Cohort selection for the study
Figure 2
Figure 2
Scatter plots demonstrating the association of the observed ln cost in the validation cohort and the predicted values of ln cost by the parsimonious model for unruptured (A) and ruptured aneurysms (B)
See this image and copyright information in PMC

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