Medicare expenditures for elderly patients undergoing surgical clipping or endovascular intervention for unruptured cerebral aneurysms

Document Type

Article

Abstract

Background The cost difference between the two treatment options (surgical clipping and endovascular therapy) for unruptured cerebral aneurysms remains an issue of debate. We investigated the association between treatment method for unruptured cerebral aneurysms and Medicare expenditures in elderly patients. Methods We performed a cohort study of 100% Medicare fee-for-service claims data for elderly patients who underwent treatment for unruptured cerebral aneurysms from 2007 to 2012. In order to control for measured confounding we used multivariable regression analysis with mixed effects to account for clustering at the Hospital Referral Region (HRR) level. An instrumental variable (regional rates of endovascular treatment) analysis was used to control for unmeasured confounding by creating pseudo-randomization on the treatment method. Results During the study period 8705 patients underwent treatment for unruptured cerebral aneurysms and met the inclusion criteria. Of these, 2585 (29.7%) had surgical clipping and 6120 (70.3%) had endovascular treatment. The median total Medicare expenditures in the first year after the admission for the procedure were 46â €..800 (IQR 31â €..000-74â €..400) for surgical clipping and 48â €..100 (IQR 34â €..500-73â €..900) for endovascular therapy. When we adjusted for unmeasured confounders, using an instrumental variable analysis, clipping was associated with increased 7-day Medicare expenditures by 3527 (95% CI 972 to 5736) and increased 1-year Medicare expenditures by 15â €..984 (95% CI 9017 to 22â €..951). Conclusions In a cohort of Medicare patients, after controlling for unmeasured confounding, we demonstrated that surgical clipping of unruptured cerebral aneurysms was associated with increased 1-year expenditures compared with endovascular treatment.

Publication Date

3-1-2017

Publication Title

Journal of NeuroInterventional Surgery

ISSN

17598478

E-ISSN

17598486

Volume

9

Issue

3

First Page

324

Last Page

328

PubMed ID

27013232

Digital Object Identifier (DOI)

10.1136/neurintsurg-2016-012313

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