1. Introduction: Surgical clipping is believed to be the more economical
procedure due to the high cost of materials in endovascular coiling. Price
for consumables average $28,780 depending on size, brand, and quantity.
The total price of coils in the procedure can range from $3,755 to
$83,259. Endovascular patients were 7% ($27,531.27) cheaper on
average than surgical clipping. The materials in coiling are more
expensive, there is a shorter hospital stay, and better patient outcomes.1
While surgical clipping has lower prices for consumables, the longer
hospital stay makes it financially comparable. Historically the outcomes
of coil procedures are better, which reinforces the benefits of cerebral
coiling, despite, on average, a moderate increase in price. Analyzing
cases based on Hunt Hess Grade and occlusion will give a more accurate
account of total price discrepancies.
Methods: 96 Atlantic Neurosurgical Specialists (ANS) aneurysm patients
in Overlook Hospital (Summit, NJ) from December of 2012 to Spring of
2014 were analyzed. 78 patients had endovascular coiling and 18 had
surgical clipping. The following information was extracted from coil
patients: coil quantity, brand, size, price, age, occlusion, length of
hospital stay, and total hospital bill. The following information was
extracted from clipping patients: occlusion, age, total hospital bill, and
length of hospital stay. Data was used to find average and difference of
hospital costs, maximum/minimum hospital stay, average hospital stay,
coils per case by brand, average price per coil based on brand, and prices
based on age.
Results: Average cost of total consumables for coiling was $28,780,
and ranged from $3,755 to $83,259. An individual coil averaged from
$3,324 to $8,373 based on brand. The average stay for an ANS patient
of the coiling procedure (16 days) is five days shorter than the average
stay for an ANS patient that had surgical clipping (21 days). The
minimum stay for coiling is 1 day, while the minimum stay for surgical
clipping is 3. The maximum stay difference is almost double (Coiling:
47 days. Clipping: 79 days). The average difference in price is $27,531
(7%), coiling being more expensive. Two 54 year-old patients showed a
difference of $188,480 between clipping and coiling, and surgical
clipping being more expensive. Coiling procedures had fewer days in
hospital, and comparable prices based on age.
Conclusion: Endovascular coiling is financially comparable to
surgical clipping yet it yields better results with fewer complications
and less time in the hospital. Given similar ages, Hunt Hess Grade,
and occlusion, coiling may even be the more affordable approach
while continuing to have all the same advantages.
1. Hoh, B. L., Y.-Y. Chi, M. F. Lawson, J. Mocco, and F. G. Barker. "Length of Stay and Total Hospital Charges of Clipping Versus Coiling for Ruptured
and Unruptured Adult Cerebral Aneurysms in the Nationwide Inpatient Sample Database 2002 to 2006." Stroke 41.2 (2010): 337-42. Web. 18 Aug.
Surgical Clipping Versus Coiling of Cerebral Aneurysms
Andrew Koslov BA; Jake Kaplan ; Ronald Benitez ,MD; B. Charles Stein MPA