Surgonomics of unruptured intracranial aneurysms.

Abstract

A comparison of reimbursement for endovascular coil embolization and surgical clipping of unruptured aneurysms has not been previously reported. The aim of this study is to assess the reimbursement to physicians and hospitals for each of these two unruptured aneurysm treatments with long-term follow-up. Hospital and physician payents were determined for 14 patients treated with coil embolization or surgical clipping of a single unruptured aneurysm per patient from 2004 to 2005, retrospectively. For this analysis, each considered hospital and physician payment encompassed one clipping or coiling procedure plus all pre- and post-operative diagnostic angiograms performed through 2007 to evaluate the treated aneurysm. Reimbursements were analyzed in three categories: physician payments, hospital payments and total payments. Average physician payments were significantly lower for coil embolization ($3422) than surgical clipping ($5645). Average length of stay after coil embolization was 2.6 days (range: 1-7) and after surgical clipping was 4.7 days (range: 2-11). The length of hospital stay directly affected hospital and total payments only, but was not significantly altered by which procedure was performed. This study suggests that physician payment for an unruptured aneurysm coil embolization treatment was statistically lower than for a surgical clip treatment. Although physicians were compensated at a lower rate for performing a coil embolization, there was no significant difference in the hospital or total payments between coil or clip treatment modalities.