Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
J Neurointerv Surg. 2010 Jun;2(2):163-7. doi: 10.1136/jnis.2009.001719.
Embolization of wide-necked intracranial aneurysms can be associated with excessive expense, especially for large/giant aneurysms. Depending on the material used, endovascular treatment may be cost prohibitive. The goal of this study was to evaluate the relative cost of various embolic agents.
Utilizing software available at http://www.angiocalc.com, theoretical aneurysm volumes were calculated using aneurysm diameters ranging from 3 to 25 mm increasing in 1 mm increments. For each volume, the software calculated the length of coil needed to fill each size of aneurysm to a consistent, standardized and desirable packing density (25% coil:aneurysm volume). Each theoretical aneurysm was embolized by filling volume in a consistent, standardized, step-wise fashion. The cost of liquid embolics was calculated by adding the cost of 1.5 ml vials of Onyx HD 500 required to fill each volume. The embolic agents were then grouped into seven categories depending on the coil type and the cost of each aneurysm size was averaged.
The average embolization with small outer diameter (0.010 inches) helical coils ranged between $714 for a 3 mm aneurysm to $113,009 for a 25 mm aneurysm, and between $2855 and $157,245 for small diameter spherical coils. Large outer diameter (>0.010 inches) helical coils cost between $2195 and $34,034 and large diameter spherical coils cost between $2195 and $86,957. Bioactive coils ranged between $1984 and $172,179, liquid embolic $5950 and $35,700, and hydrocoils $1295 and $32,873.
Larger outer diameter helical coils, hydrocoils and liquid embolics provide a relative cost savings compared with standard, spherical or bioactive coils when aneurysm size, shape, packing density and embolic agent were controlled and standardized. This cost differential increases as the size of the aneurysm increases.
宽颈颅内动脉瘤的栓塞治疗费用可能较高，尤其是对于大型/巨型动脉瘤。根据使用的材料，血管内治疗可能费用过高。本研究的目的是评估各种栓塞剂的相对成本。
利用可在 http://www.angiocalc.com 上获取的软件，使用直径范围为 3 至 25 毫米、以 1 毫米递增的动脉瘤直径计算理论动脉瘤体积。对于每个体积，软件计算出填充每个大小动脉瘤所需的线圈长度，以达到一致、标准化和理想的填充密度（25%线圈：动脉瘤体积）。每个理论动脉瘤均以一致、标准化的逐步方式进行填充。通过以一致、标准化的方式逐步填充体积来计算液体栓塞剂的成本。将每个体积所需的 1.5 毫升 Onyx HD 500 小瓶的成本相加，即可计算出液体栓塞剂的成本。然后，根据线圈类型将栓塞剂分为七类，并计算出每个动脉瘤大小的平均成本。
使用小外径（0.010 英寸）螺旋线圈进行平均栓塞治疗，3 毫米动脉瘤的费用为 714 美元，25 毫米动脉瘤的费用为 113,009 美元；小直径球形线圈的费用为 2855 美元至 157,245 美元。大外径（>0.010 英寸）螺旋线圈的费用为 2195 美元至 34,034 美元，大直径球形线圈的费用为 2195 美元至 86,957 美元。生物活性线圈的费用为 1984 美元至 172,179 美元，液体栓塞剂的费用为 5950 美元至 35,700 美元，水凝胶圈的费用为 1295 美元至 32,873 美元。
在控制和标准化动脉瘤的大小、形状、填充密度和栓塞剂的情况下，与标准的、球形或生物活性线圈相比，大外径螺旋线圈、水凝胶圈和液体栓塞剂的相对成本节省，随着动脉瘤的增大，这种成本差异会增加。
