Introduction Embolization of wide-necked intracranial aneurysms can be associated with excessive expense, especially for large/giant aneurysms. Depending on the material used, endovascular treatment may be cost prohibitive. The goal of this study was to evaluate the relative cost of various embolic agents.
Methods Utilizing software available at http://www.angiocalc.com, theoretical aneurysm volumes were calculated using aneurysm diameters ranging from 3 to 25 mm increasing in 1 mm increments. For each volume, the software calculated the length of coil needed to fill each size of aneurysm to a consistent, standardized and desirable packing density (25% coil:aneurysm volume). Each theoretical aneurysm was embolized by filling volume in a consistent, standardized, step-wise fashion. The cost of liquid embolics was calculated by adding the cost of 1.5 ml vials of Onyx HD 500 required to fill each volume. The embolic agents were then grouped into seven categories depending on the coil type and the cost of each aneurysm size was averaged.
Results The average embolization with small outer diameter (0.010 inches) helical coils ranged between $714 for a 3 mm aneurysm to $113 009 for a 25 mm aneurysm, and between $2855 and $157 245 for small diameter spherical coils. Large outer diameter (>0.010 inches) helical coils cost between $2195 and $34 034 and large diameter spherical coils cost between $2195 and $86 957. Bioactive coils ranged between $1984 and $172 179, liquid embolic $5950 and $35 700, and hydrocoils $1295 and $32 873.
Conclusions Larger outer diameter helical coils, hydrocoils and liquid embolics provide a relative cost savings compared with standard, spherical or bioactive coils when aneurysm size, shape, packing density and embolic agent were controlled and standardized. This cost differential increases as the size of the aneurysm increases.
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Competing interests The senior author (RAM) performs physician training and physician proctoring for Onyx HD 500, for which he receives compensation from eV3. No other author on this paper has any financial relationship of any sort with eV3 or any other company.
Provenance and peer review Not commissioned; not externally peer reviewed.
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