Introduction/purpose Interventional stroke management has seen a period of explosive growth in the wake of recent trials demonstrating improved outcomes in patients who undergo timely and appropriate procedural management. The two most common interventional techniques involve the use of stent retrieval devices and suction aspiration. While clear clinical benefit to the patient has been seen in the use of these devices, it is not altogether clear the financial implications to the patient and/or his or her insurer for the use of these devices. In a period of heightened sensitivity to healthcare costs, it is reasonable to consider the material cost to the patient and healthcare system for utilization of these new techniques. The goal of our study is to determine the difference, if any, in cost to the healthcare system in performance of interventional thrombectomy by stent retrieval or suction aspiration.
Materials and methods We examined data for interventional stroke management cases performed for M1 segment occlusions at Duke University Medical Center from the period of January 2014 to January 2016. We analyzed the amount billed to the patient for products utilized during these cases. Cases were subdivided into those only utilizing stent retrieval devices (SolitaireTM; Covidien, Dublin, Ireland) and those only utilizing suction aspiration devices (Penumbra®, Alameda, CA). Total cost to patient for each case was calculated. Mean cost and standard deviation was calculated for each technique and compared using Student’s t-test.
Results The total product cost to the patient for interventional management of vascular occlusions in a selected group of patients is given in the table.
Conclusion A cursory evaluation of the data from this selected subset of patients suggests that there may be no significant difference in overall product cost to the patient for utilization of these two techniques for performance of mechanical thrombectomy. However, upon closer inspection of the data, the cost for aspiration thrombectomy appears to vary quite widely across the subset, with a standard deviation of $22470.99, while the standard deviation for stent retrieval is $2846.91. It is difficult to determine whether this trend would be borne out in a larger sample set; however, it may suggest that product utilization in aspiration thrombectomy may vary considerably among operators and in varying situations while product utilization in stent retrieval thrombectomy may be more constant. Further exploration of this trend with larger patient subsets is warranted.
Disclosures P. Brown: None. M. Cobb: None. T. Smith: None. A. Zomorodi: None. L. Gonzalez: None.
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