Graduate School of Medical Sciences, School of Medicine, Kyushu University, Fukuoka, Japan.
National Institute of Public Health, Saitama, Japan.
Neurosurgery. 2020 Jul 1;87(1):63-70. doi: 10.1093/neuros/nyz377.
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.
To compare retreatment rates and healthcare expenditures between FDs and conventional coiling-based treatments in all eligible cases in Japan.
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.
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.
In this national-level study, FDs demonstrated significantly lower retreatment rates and total expenditures than conventional coiling with ≥ 9 coils.
血流导向装置（FDs）的出现标志着大型未破裂颅内动脉瘤血管内治疗的创新开始，但尚未从临床和经济角度对这些装置进行多机构研究。
比较 FD 与传统基于线圈的治疗方法在日本所有符合条件的病例中的再治疗率和医疗保健支出。
我们从国家级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。主要结局指标是再治疗率和 1 年总医疗保健支出，将接受 FD、线圈和支架辅助线圈（SAC）治疗的患者进行比较。线圈和 SAC 组根据使用的线圈数量进一步分类。使用 Cox 比例风险模型分析再治疗率，使用多层次混合效应广义线性模型分析总支出。
研究样本包括 512 名 FD 患者、1499 名线圈患者和 711 名 SAC 患者。使用≥10 个线圈和≥9 个线圈的线圈组再治疗率明显高于 FD 组，风险比分别为 2.75（1.30-5.82）和 2.52（1.24-5.09）。此外，使用≥10 个线圈的线圈组和使用≥10 个线圈的 SAC 组的 1 年支出明显高于 FD 组，成本比（95%CI）分别为 1.30（1.13-1.49）和 1.31（1.15-1.50）。
在这项国家级研究中，FD 与使用≥9 个线圈的传统线圈相比，再治疗率和总支出明显更低。
