Is coiling really more costly than clipping in patients with ruptured intracranial aneurysm?

Dileep R Yavagal

This article has no abstract so we have provided the first paragraph of the full text.

New health-care technologies are believed to be one of the reasons for increasing health-care costs.¹ While newer treatments might result in superior clinical outcomes compared with older treatments, if the cost of the new treatment is exorbitantly high, its cost-effectiveness could be limited. Value-based decision-making when choosing between available treatments is recommended to control health spending.² Coil embolization has rapidly emerged as a minimally invasive alternative to surgical clipping for the treatment of cerebral aneurysms in the past decade. The coils used in aneurysm embolization are expensive and multiple coils are usually required to treat a single aneurysm, which has led to the assumption that coil embolization is costlier than clipping. In 2002, the results of ISAT, a multicenter, international, randomized controlled trial, showed that coil embolization of cerebral aneurysms results in superior clinical outcomes at 1 year compared with clipping in patients with acute SAH.³ While the ISAT trial has changed practice in terms of SAH treatment, especially in Europe and also to some extent in North America, only limited data from two single-center studies are available to compare the cost of coil embolization with that of surgical clipping.

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