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Original research
Optimizing resources: financial evaluation of flow diverters versus stent assisted coiling in large and giant cerebral aneurysm management in Brazil public health system
  1. Elias Antônio Tanus Machado1,
  2. Savio Batista1,2,
  3. Fausto de Oliveira Braga1,
  4. Cesar Augusto Ferreira Alves Filho1,
  5. Jose Alberto Almeida Filho1,
  6. Plínio Gabriel Lopes1,
  7. Carlos Leandro Cartobei1,
  8. Leonardo de Barros Oliveira3,
  9. Paulo José da Mata Pereira4,
  10. Paulo Niemeyer Filho4
  1. 1Department of Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
  2. 2Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
  3. 3Department of Medicine, State University of Ponta Grossa, Ponta Grossa, Brazil
  4. 4Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
  1. Correspondence to Dr Savio Batista, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, 21941-599, Brazil; saviobatista360{at}gmail.com

Abstract

Background Cerebral aneurysms, especially large and giant aneurysms, pose challenges in neurointerventional surgery. Treatment choices involve clinical presentation, aneurysm details, and global resource variations. Neurointerventional methods, while innovative, may be cost restrictive in certain regions. In public healthcare, cost is crucial, notably in countries like Brazil. This study examines the device specific cost estimation of flow diverters (FD) and traditional stent assisted coiling (SAC) for large and giant cerebral aneurysms, providing insights into optimizing neurosurgical interventions within the Brazilian public health system’s unique challenges.

Methods A comprehensive retrospective analysis was conducted at our medical center of cases of large and giant aneurysms treated between 2013 and 2023. Determination of the estimated number of coils for aneurysms previously treated with FDs at our center was made, with the cost of each case, and the difference between both treatments was calculated.

Results We investigated the profiles of 77 patients: 40 had large aneurysms (51.9%) and 37 had giant aneurysms (48.1%). Large aneurysms had a mean cost difference of US$274 (standard deviation (SD) $2071), underscoring the device specific cost estimation of FDs over SAC in their treatment. For giant aneurysms, the mean cost difference increased to $6396 (SD $2694), indicating FDs as the more economically sound choice.

Conclusion Our study indicated that, for the treatment of giant aneurysms and some large aneurysms, the FD intervention was more economical than SAC.

  • Flow Diverter
  • Aneurysm
  • Coil
  • Economics

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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Footnotes

  • Twitter @saviobatista360

  • Contributors All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by SB, PGL, and CLC. The first draft of the manuscript was written by SB, LdBO, and EATM. JAAF, CAFAF, FdOB, PJdMP, and PNF commented on previous versions of the manuscript. SB was the guarantor. All authors read and approved the final manuscript.

  • 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.