Analisi dei costi del trattamento dell’aneurisma intracranico in Italia

Objectives: To investigate the hospital length of stay (LOS) and total direct costs of management of patients with intracranial aneurysm in Italy. To test whether treatment choices impact LOS and total direct costs. Design: Data were collected in a prospective, incidence-based, observational multicentre study. Patients were enrolled in a consecutive manner in 27 hospitals stratified according to macro-areas (North, Centre and South) and volume of activity (number of aneurysm patients treated annually). The costs were evaluated through a bottom-up, microcosting approach. The associations between demographic characteristics, clinical variables, modality of treatment and LOS/total costs were examined in two multiple regression models. Results: A total of 473 patients with single aneurysm were enrolled from October 1st 2005 to November 30th 2006 across the country. The average length of stay was 19.8 days while the total direct costs per patient were €21,810. The overheads represented the most important cost category (€15,867), followed by supplies used during treatment procedure (€3026), personnel (€1042) and diagnostic imaging (€591). Fifty four % of patients were treated with endovascular (coiling) approach while the rest was submitted to surgical intervention (clipping). After adjusting for covariates, three significant predictors of hospital LOS were identified: Hunt & Hess (H&H) level, geographical area and choice of treatment, while the type of admitting organizational unit represented one additional predictor of total costs. One additional point on H&H scale resulted in increasing LOS by 14% (p<0.001) and total costs by 16% (p<0.001), holding other variables constant. The choice of treatment also predicts the outcome: endovascular approach decreases LOS by 39% (p=0.001) without significant reduction of total costs (p=0.4). Conclusions: The intracranial aneurysm treatment poses significant economic burden on hospitals. The current analysis indicates that choice of endovascular therapy is associated with decreased hospital length of stay.