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Original research
A predictive model of hospitalization cost after cerebral aneurysm clipping
  1. Kimon Bekelis1,
  2. Symeon Missios2,
  3. Todd A MacKenzie3,4,5,
  4. Nicos Labropoulos6,
  5. David W Roberts7,8
  1. 1Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  2. 2Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  4. 4Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  5. 5The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
  6. 6Section of Vascular Surgery, SUNY Stony Brook, Stony Brook, New York, USA
  7. 7Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
  8. 8Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  1. Correspondence to Dr K Bekelis, Dartmouth-Hitchcock Medical Center, One Medical Center, Lebanon, New Hampshire NH 03756, USA; kbekelis{at}


Background Cost containment is the cornerstone of the Affordable Care Act. Although studies have compared the cost of cerebral aneurysm clipping (CAC) and coiling, they have not focused on identification of drivers of cost after CAC, or prediction of its magnitude. The objective of the present study was to develop and validate a predictive model of hospitalization cost after CAC.

Methods We performed a retrospective study involving CAC patients who were registered in the Nationwide Inpatient Sample (NIS) database from 2005 to 2010. The two cohorts of ruptured and unruptured aneurysms underwent 1:1 randomization to create derivation and validation subsamples. Regression techniques were used for the creation of a parsimonious predictive model.

Results Of the 7798 patients undergoing CAC, 4505 (58%) presented with unruptured and 3293 (42%) with ruptured aneurysms. Median hospitalization cost was US$24 398 (IQR $17 079 to $38 249) and $73 694 (IQR $46 270 to $115 128) for the two cohorts, respectively. Common drivers of cost identified in the multivariate analyses included the following: length of stay, number of admission diagnoses and procedures, hospital size and region, and patient income. The models were validated in independent cohorts and demonstrated final R2 values very similar to the initial models. The predicted and observed values in the validation cohort demonstrated good correlation.

Conclusions This national study identified significant drivers of hospitalization cost after CAC. The presented model can be utilized as an adjunct in the cost containment debate and the creation of data driven policies.

  • Aneurysm
  • Economics
  • Intervention
  • Subarachnoid

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