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Author Zubair Tahir, M.; Enam, S.A.; Pervez Ali, R.; Bhatti, A.; ul Haq, T. url  doi
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  Title Cost-effectiveness of clipping vs coiling of intracranial aneurysms after subarachnoid hemorrhage in a developing country--a prospective study Type Journal Article
  Year 2009 Publication Surgical Neurology Abbreviated Journal Surg Neurol  
  Volume 72 Issue 4 Pages 355-60; discussion 360-1  
  Keywords Adult; Cost-Benefit Analysis; *Developing Countries; Embolization, Therapeutic/economics/instrumentation/methods; Female; Humans; Intracranial Aneurysm/pathology/radiography/*surgery; Male; Middle Aged; Neurosurgical Procedures/*economics/*instrumentation/methods; Outcome Assessment (Health Care)/methods; Pakistan; Postoperative Complications/epidemiology/prevention & control; Prospective Studies; Prostheses and Implants/economics/statistics & numerical data; Risk Factors; Subarachnoid Hemorrhage/pathology/radiography/*surgery; Surgical Instruments/economics/statistics & numerical data; Vascular Surgical Procedures/*economics/*instrumentation/methods  
  Abstract BACKGROUND: Endovascular coil treatment is being used increasingly as an alternative to clipping for some ruptured intracranial aneurysms. The relative benefits of these 2 approaches have yet to be fully established. The aim of this study was to compare the clinical outcome, resource consumption, and cost-effectiveness of endovascular treatment vs surgical clipping in a developing country. METHODS: The study population consisted of 55 patients with aneurysmal subarachnoid hemorrhage (SAH) identified prospectively from January 2004 to June 2007. Of the 55 patients with ruptured intracranial aneurysms, 31 underwent surgical clipping, whereas 24 were treated via interventional coils. Clinical outcome at 6 months, using the modified Rankin Scale, and cost of treatment related to all aspects of the inpatient stay were evaluated in both groups. RESULTS: The average age of the patients in the endovascular group was 38 years, whereas in the surgical group, it was 45 years. Most patients (43) were found to be in grades (1 and 2). Of these patients, 18 received coils and 25 were clipped. The remaining 12 patients were of poor grades (3 and 4), of which 6 had coiling and 6 underwent clipping. Most the patients (46/55) had anterior circulation aneurysms, and the rest of the patients (9/55) had posterior circulation aneurysms. The clinical outcome was similar in comparison (good in 81% for clipping and 83% for coiling). The average total cost for patients undergoing endovascular treatment of the aneurysms was $5080, whereas the average total cost of surgical clipping was $3127. CONCLUSION: Patients with aneurysmal SAH whom we judged to require coiling had higher charges than patients who could be treated by clipping. The benefits of apparent decrease in length of stay in the endovascular group were offset by higher procedure price and cost of consumables. There was no significant difference in clinical outcome at 6 months. We have proposed a risk scoring system to give guidelines regarding the choice of treatment considering size of aneurysm and resource allocation.  
  Address Department of Neurosurgery, Aga Khan University Hospital, Karachi 74800, Pakistan  
  Corporate Author Thesis  
  Publisher Place of Publication Editor (up)  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0090-3019 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:19616277 Approved no  
  Call Number refbase @ user @ Serial 10169  
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