ORIGINAL

Association Between the Cost of Treating Intracranial Aneurysms with the Technique Used, Topography and Classification at Admission Scales, in a Brazilian Public Service

Associação entre o Custo do Tratamento de Aneurismas Intracranianos com a Técnica Utilizada, Topografia e Classificação nas Escalas de Admissão em um Serviço Público Brasileiro

  • Paulo Ramos Botelho Antunes 1 2    Paulo Ramos Botelho Antunes 1 2
  • Fabricio Tinôco Alvim de Souza 3    Fabricio Tinôco Alvim de Souza 3
  • Marcos Álvares de Campos 1 2    Marcos Álvares de Campos 1 2
  • Elisa Carvalho de Siqueira 1    Elisa Carvalho de Siqueira 1
  • Fabiano Franco Monteiro Prado 1 2    Fabiano Franco Monteiro Prado 1 2
  • Francisco de Souza Coelho Junior 4    Francisco de Souza Coelho Junior 4
  • Carlos Batista Alves de Souza Filho 5    Carlos Batista Alves de Souza Filho 5
  • Gerival Vieira Junior 5    Gerival Vieira Junior 5
  • Ricardo Souza Quadros 6    Ricardo Souza Quadros 6
  • Maria Carolina Barbosa Álvares 1 2    Maria Carolina Barbosa Álvares 1 2
  • Marcos Dellareti 5 7    Marcos Dellareti 5 7
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Resumo

Introdução: a ruptura de um aneurisma é uma situação extremamente grave, uma condição clínica com alta letalidade que requer tratamento eficaz. Objetivo: analisar o custo-efetividade de dois procedimentos (clipagem cirúrgica versus terapia endovascular) para tratamentos intracranianos. Métodos: um total de 129 indivíduos com aneurisma intracraniano (AI) foram dicotomizados de acordo com o tratamento do aneurisma: tratamento endovascular versus tratamento cirúrgico. Condições clínicas, classificação nas escalas de admissão e custos financeiros foram avaliados para cada grupo. Resultados: do total, 28,7% eram do sexo masculino e 71,3% do sexo feminino. A média de idade foi de 50,77 ± 12,23 e a mediana de 51 (12,5) anos. Um único aneurisma foi encontrado em 96,1% dos pacientes e múltiplos aneurismas em 3,9%. Em relação à técnica, 53,5% dos aneurismas foram tratados por clipagem cirúrgica e 46,5% dos aneurismas pela técnica endovascular. Houve um custo hospitalar total com tratamento AI de US$ 1.476.195,00, dos quais US$ 721.335,00 foram gastos com técnica endovascular e US$ 754.859,00 com clipagem cirúrgica. A escala de Hunt & Hess influencia nos valores de custo dos pacientes. A escala de Glasgow tem relação inversamente proporcional ao custo hospitalar total, ou seja, quanto maior a escala de Glasgow do paciente, menor é o gasto hospitalar. Conclusão: nosso estudo reforça a observação clínica de que o uso da técnica de clipagem cirúrgica terapêutica geralmente tem gastos menos onerosos do que aqueles que utilizaram técnicas endovasculares. As escalas de Hunt & Hess e Glasgow podem ser ferramentas úteis para o planejamento de custos de pacientes internados em centros hospitalares para o tratamento de aneurismas.

Palavras-chave

Aneurismas intracranianos; Treatmentos; Clip cirúrgico; Terapia endovascular; Custos; Escala de coma de Glasgow; Escala Hunt e Hess

Abstract

Introduction: the rupture of an aneurysm is an extremely serious situation, a clinical condition with high lethality that requires effective treatment. Objective: we aimed to analyze the cost-effectiveness of two procedures (surgical clipping versus endovascular therapy) for intracranial treatments. Methods: 129 individuals with ruptured intracranial aneurysm (IA) were dichotomized according to aneurysm treatment: endovascular treatment versus surgery treatment. Clinical conditions, classification at admission scales and financial costs were evaluated for each group. Results: a total of 28.7% were male and 71.3% were female. The mean age was 50.77 ± 12.23 and the median was 51 (12.5) years old. Single aneurysm was found in 96.1% of the patients, and multiple aneurysms in 3.9%. Regarding technique, 53.5% of the aneurysms were treated by surgical clipping and 46.5% of the aneurysms by the endovascular technique. There was a total hospital cost with IA treatment of US$ 1,476,195.00, which US$ 721,335.00 were spent with endovascular technique and US$ 754,859.00 with surgical clipping. The Hunt & Hess scale influences the cost values of patients. The Glasgow scale has an inversely proportional relation to the total hospital cost, that is, the higher the patient’s Glasgow scale, the lower is the hospital expenses. Conclusion: our study reinforces the clinical observation that the use of therapeutic surgical clipping technique generally has less costly expenses than accounts that used endovascular techniques. The Hunt & Hess and Glasgow scales can be useful tools for planning the costs of patients admitted to hospital centers for the treatment of aneurysms.


Keywords

Intracranial aneurysms; Treatments; Surgical clipping; Endovascular therapy; Costs; Glasgow scale; Hunt & Hess scale

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1Research Group on Diagnostic and Therapeutic Radiology, Hospital Santa Casa, Belo Horizonte, MG, Brazil.

2Service of Radiology, Hospital Santa Casa, Belo Horizonte, MG, Brazil.

3Department of Dental Clinic-Diagnostic Core, Dental School, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil.

4Service of Planning and Controllership, Hospital Santa Casa, Belo Horizonte, MG, Brazil.

5Service of Neurosurgery, Hospital Santa Casa, Belo Horizonte, MG, Brazil.

6Service of Interventional Neuroradiology, Hospital Santa Casa, Belo Horizonte, MG, Brazil.

7Instituto de Educação e Pesquisa da Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil.

 

Received: June 11, 2024

Accepted: June 25, 2024

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