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

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Medical Device Technology

Background:

• Cerebral aneurysms pose significant risks, necessitating effective treatment strategies.
• Guglielmi detachable coils (GDC) embolization and surgical neck clipping are established treatments for ruptured cerebral aneurysms.
• Comparative cost-efficacy analyses are crucial for guiding clinical and healthcare decisions.

Purpose of the Study:

• To compare the cost and efficacy of Guglielmi detachable coils (GDC) embolization versus conventional surgical aneurysmal neck clipping for acutely ruptured cerebral aneurysms.
• To evaluate the medico-financial implications of GDC embolization in diverse patient populations and aneurysm locations.

Main Methods:

• Retrospective analysis of twenty consecutive patients treated with GDC embolization and twenty with surgical neck clipping.
• Comparison of patient demographics, aneurysm characteristics (MCA vs. posterior circulation), and clinical outcomes.
• Analysis of treatment costs based on the Japanese Medical Insurance and Payment System.

Main Results:

• The GDC group had higher patient age and poorer Hunt and Kosnik grades.
• No significant difference in mean medical costs was observed between the GDC (477,890 points) and neck clipping (456,084 points) groups.
• The cost of implanted medical devices contributed to the total expense in the GDC group.

Conclusions:

• GDC embolization is a preferred strategy for acutely ruptured cerebral aneurysms, particularly in surgically challenging, elderly, or poor-grade patients.
• GDC embolization demonstrates satisfactory medico-financial performance, comparable to surgical neck clipping.
• The choice between GDC embolization and surgical clipping should consider patient-specific factors and aneurysm complexity.