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E-062 Coiling Cost per Volume Analysis and Strategy for Cost Reduction
  1. C Wang1,
  2. F Hui2
  1. 1Case Western Reserve University, Cleveland, OH
  2. 2Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH


Introduction/Purpose Aneurysm treatment is a major revenue driver of neurointerventional surgery. The cost of devices used during treatment has a direct effect on the profitability and financial sustainability of a given therapy. For aneurysm coiling procedures, the major component of material costs is the cost of implanted coils. As the healthcare system becomes increasingly cost-sensitive, understanding and controlling costs will prove to be instrumental in maintaining the future health of the specialty while maintaining patient outcomes.

Stable coil embolisation and aneurysm occlusion is not well understood, but may relate to packing density - achieving a minimum sum total coil volume. Other approaches include achieving lower porosity ratios at inflow zone of the aneurysm, which may achieve functional occlusion of an aneurysm despite residual internal unfilled volume. This approach is best exemplified by flow diversion devices.

Modelling the second approach is currently not feasible, as critical factors remain poorly understood, but modelling a reasonable strategy for minimising procedure material costs to achieve a minimum packing density may help identify methods of reducing coiling costs on a volumetric efficiency basis. To date no analysis has been done to model this relationship.

Materials and Methods The price information for 468 different coils used by our institution were obtained by Q-Sight and normalised to the price of the least expensive coil. Coil volumes were lifted from the database of AngioSuite Neuro Edition software. Coils were grouped as frame, finish or fill coils by FKH by tertiary structural elements for framing coils, and size and length for finishing coils.

Results Mean normalised coil cost per volume by categories yield 0.22 ± 0.24/mm3 for framing coils, 0.25 ± 0.22/mm3 for fill coils, and 0.99 ± 0.81 for finish coils. Between categories, there was no significant difference (p=0.32) between frame vs fill coils, but an extremely significant difference between both of the former vs finish coils (p < 0.000001). Individual cost/volume of each coil are collectively displayed in figure 1, grouped by coil type.

Conclusions As a class, finishing coils are approximately 4 times as expensive as their frame and filling counterparts. Upon closer of figure 1 though, as a general trend smaller coils, regardless of frame, fill or finish designation, have a much higher cost per volume.

This analysis suggests that the approach when coiling to minimise costs is to always insert the largest volume coil possible.

Disclosures C. Wang: None. F. Hui: None.

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