Comparing Retreatments and Expenditures in Flow Diversion Versus Coiling for Unruptured Intracranial Aneurysm Treatment: A Retrospective Cohort Study Using a Real-World National Database
Comparing Retreatments and Expenditures in Flow Diversion Versus Coiling for Unruptured Intracranial Aneurysm Treatment: A Retrospective Cohort Study Using a Real-World National Database
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DOI：
10.1093/neuros/nyz377
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发表时间：
2020-07-01
期刊：
影响因子：
4.8
通讯作者：
Yamamoto, Tetsuya
中科院分区：
文献类型：
--
作者：
Fukuda, Haruhisa;Sato, Daisuke;Yamamoto, Tetsuya
背景：分流装置(FDs)标志着未破裂的大型颅内动脉瘤血管内治疗创新的开始，但从临床和经济角度对这些装置还没有进行多机构研究。目的：比较日本所有符合条件的病例中FDs和传统弹簧圈治疗的再治疗率和医疗费用。方法：我们从国家层面的索赔数据库中确定了在研究期间(2015年10月至2018年3月)接受血管内治疗的患者。结果指标是再治疗率和一年的总医疗费用，比较了接受过FD、卷绕和支架辅助卷绕(SAC)治疗的患者。根据使用的线圈数量进一步对线圈组和SAC组进行分类。再治疗率用COX比例风险模型分析，总费用用多水平混合效应广义线性模型分析。结果：研究样本包括512例FD患者、1499例盘绕患者和711例SAC患者。使用>；=10个线圈和>；=9个线圈组的再治疗率显著高于FD组，危险比分别为2.75(1.30~5.82)和2.52(1.24~5.09)。此外，使用10个线圈的FD组和使用10个线圈的SAC组的1年费用显著高于FD组，其成本比(95%CI)分别为1.30(1.13-1.49)和1.31(1.15-1.50)。结论：在这项全国性研究中，FDS的再治疗率和总费用显著低于使用>；=9个线圈的常规线圈组。
BACKGROUND: Flow diverters (FDs) have marked the beginning of innovations in the endovascular treatment of large unruptured intracranial aneurysms, but no multi-institutional studies have been conducted on these devices from both the clinical and economic perspectives.OBJECTIVE: To compare retreatment rates and healthcare expenditures between FDs and conventional coiling-based treatments in all eligible cases in Japan.METHODS: We identified patients who had undergone endovascular treatments during the study period (October 2015-March 2018) from a national-level claims database. The outcome measures were retreatment rates and 1-yr total healthcare expenditures, which were compared among patients who had undergone FD, coiling, and stent-assisted coiling (SAC) treatments. The coiling and SAC groups were further categorized according to the number of coils used. Retreatment rates were analyzed using Cox proportional hazards models, and total expenditures were analyzed using multilevel mixed-effects generalized linear models.RESULTS: The study sample comprised 512 FD patients, 1499 coiling patients, and 711 SAC patients. The coiling groups with >= 10 coils and >= 9 coils had significantly higher retreatment rates than the FD group with hazard ratios of 2.75 (1.30-5.82) and 2.52 (1.24-5.09), respectively. In addition, the coiling group with >= 10 coils and SAC group with >= 10 coils had significantly higher 1-year expenditures than the FD group with cost ratios (95% CI) of 1.30 (1.13-1.49) and 1.31 (1.15-1.50), respectively.CONCLUSION: In this national-level study, FDs demonstrated significantly lower retreatment rates and total expenditures than conventional coiling with >= 9 coils.