Cost Evaluation of Endovascular Coiling and Surgical Clipping of Intracranial Aneurysm: A Systemic Review

Introduction: Cost-effectiveness of medical intervention is becoming increasingly important in healthcare delivery. Treatment in neurosurgery is extremely expensive and there have been very few publications on neurosurgical health economics and comparative effectiveness analysis of neurosurgical procedures. Previous studies which had compared the costs of clipping and coiling were held out in European centers with data specifically from the ISAT study conducted in Europe. No significant differences were seen in the total cost of coiling when compared to clipping in a time period of one year. Methods: A systematic literature search was conducted using electronic databases including MEDLINE and EMBASE. The inclusion criteria included the literature search limited to the last 10 years (2006-2016), studies on adult human patients, and papers published in English. All editorials, comments and correspondences were excluded from this study. Results: Systematic literature search yielded 5784 studies. After removing duplicates and non-relevant studies, finally five studies had specifically analyzed cost economics of coiling and clipping of intracranial aneurysm. Overall, coiling was more expensive than clipping in three studies. The study which was conducted by Wolsteholme et al. showed no significant differences between the two procedures in terms of their costs. Conclusion: Cost evaluations of intracranial aneurysm showed that surgical clipping results to reduced re-operation rate when compared to endovascular coiling, associated with increased complications, longer hospital stays and ultimately greater hospital costs.