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Original research
Impact of insurance type on national variation in cost of endovascular treatment for unruptured cerebral aneurysms
  1. Matthews Lan1,
  2. Campbell Liles2,
  3. Pious D Patel1,
  4. Stephen R Gannon3,
  5. Rohan V Chitale2
  1. 1 Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  2. 2 Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  3. 3 Pediatric Neurosurgery, Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
  1. Correspondence to Matthews Lan, School of Medicine, Vanderbilt University School of Medicine, Nashville TN 37212, Tennessee, USA; matthews.lan{at}


Background Identifying drivers of nationwide variation in healthcare costs could help reduce overall cost. Endovascular treatment for unruptured cerebral aneurysms (ETUCR) is an elective neurointerventional procedure that allows for detailed analysis of cost variation. This study aimed to investigate the role of insurance type in cost variation of ETUCR.

Methods A retrospective analysis of patients undergoing ETUCR was done. Demographic and hospital data were obtained from the National Inpatient Sample 2012–2015. Multivariate analysis was done using a generalized linear model. Oaxaca–Blinder decomposition was performed to identify factors driving cost variation.

Results There was a significant difference in median cost ($25 331.82 vs $25 825.25, respectively, P<0.001) as well as length of stay (P<0.001) and complications (P<0.001) between patients with private insurance and Medicare. In multivariate analysis, insurance type was not predictive of increased cost. Among patients aged 65–75 years there was a higher median cost with private insurance compared to Medicare ($28 373.85 vs $25 558.25, respectively, P<0.001) but no difference in complications or length of stay. Oaxaca–Blinder decomposition showed higher marginal costs associated with private insurance patients at hospitals with greater endovascular operative volume (P=0.015).

Conclusions In patients aged 65–75 years, private insurance is associated with higher costs compared to Medicare; however, insurance type is not predictive of increased cost in multivariate analysis. Differential treatment of private insurance and Medicare patients at hospitals with greater operative volume seems to influence this difference, likely due to differential reimbursement schemes that lead to weaker cost controls.

  • aneurysm
  • economics
  • coil

Data availability statement

All data are available upon reasonable request to the corresponding author.

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Data availability statement

All data are available upon reasonable request to the corresponding author.

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  • Collaborators Chevis N Shannon.

  • Contributors ML filtered and analyzed data, was the primary contributor to writing the manuscript, and was responsible for the majority of revisions and submission. CL helped conceive the research idea and contributed to writing and revising the manuscript. PDP contributed to data filtering and manuscript writing. SRG helped with obtaining data and filtering. RVC supported the entire project and contributed to manuscript writing and revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.