Reduced 2-year aneurysm retreatment and costs among patients treated with flow diversion versus non-flow diversion embolization: A Premier Healthcare Database retrospective cohort study
The use of endovascular treatments, including Pipeline embolization devices (PEDs) and coiling approaches (non-PEDs), has played an increasingly important role in the treatment of intracranial aneurysms. Despite multiple studies evaluating PEDs, a real-world evaluation of follow-up outcomes and cost...
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| description | The use of endovascular treatments, including Pipeline embolization devices (PEDs) and coiling approaches (non-PEDs), has played an increasingly important role in the treatment of intracranial aneurysms. Despite multiple studies evaluating PEDs, a real-world evaluation of follow-up outcomes and costs remains to be completed. The Premier Healthcare Database (PHD), 2010-2017, was queried to identify patients with unruptured intracranial aneurysms treated endovascularly. Rates of readmission, retreatment, and cost at the same hospital were compared between patients who underwent PED and non-PED endovascular treatments of their aneurysms. One-to-three (PED-to-non-PED) propensity score (PS) matching was performed to adjust for potential case selection bias into the PED cohort, with covariates including age group, sex, Charlson Comorbidity Index (CCI) group, payor, region, and randomized hospital identifier. A total of 679 patients underwent PED placement and 8432 had non-PED treatments. Prior to PS matching, there were significant but minor differences in age (56.7±12.8 vs. 58.2±12.6 years, p = 0.004) and sex (male 16.6% vs. 24.4%, p |
| doi_str_mv | 10.1371/journal.pone.0234478 |
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Despite multiple studies evaluating PEDs, a real-world evaluation of follow-up outcomes and costs remains to be completed. The Premier Healthcare Database (PHD), 2010-2017, was queried to identify patients with unruptured intracranial aneurysms treated endovascularly. Rates of readmission, retreatment, and cost at the same hospital were compared between patients who underwent PED and non-PED endovascular treatments of their aneurysms. One-to-three (PED-to-non-PED) propensity score (PS) matching was performed to adjust for potential case selection bias into the PED cohort, with covariates including age group, sex, Charlson Comorbidity Index (CCI) group, payor, region, and randomized hospital identifier. A total of 679 patients underwent PED placement and 8432 had non-PED treatments. Prior to PS matching, there were significant but minor differences in age (56.7±12.8 vs. 58.2±12.6 years, p = 0.004) and sex (male 16.6% vs. 24.4%, p<0.0001) for PED and non-PED, respectively, but no differences in CCI (p = 0.08), length of stay (p = 0.88), or rate of routine discharge (p = 0.21). All-cause readmission/emergency department reevaluation rates in the two cohorts were similar at 30, 90, and 180 days and 1 and 2 years. Our results identified a significantly lower retreatment rate for PEDs at all follow-up time points over a 2-year period (range: 0.9-8.1%) compared with non-PED treatments (range: 1.7-11.6%). These findings remained consistent after PS matching: all-cause readmission/reevaluation rates were significantly lower in patients treated with PED at 90 days, 180 days, 1 year, and 2 years (p<0.001). Although the initial treatment costs were higher for PED at time of treatment (p<0.001), cumulative follow-up emergency department visit and readmission costs (inclusive of patients with no readmission and/or no retreatment) were significantly lower for patients with initial PED relative to non-PED treatment at 2 years (p = 0.021). These results suggest that PEDs may potentially reduce downstream retreatment rates and costs. Further work is required to improve identification of patient subgroups that could benefit from PED over non-PED treatments both initially and during follow-up.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0234478</identifier><identifier>PMID: 32555657</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Age ; Analysis ; Aneurysm ; Aneurysms ; Biology and Life Sciences ; Cardiovascular system ; Care and treatment ; Cerebral aneurysm ; Codes ; Cohort analysis ; Comorbidity ; Costs ; Demographic aspects ; Embolization ; Emergency medical care ; Emergency medical services ; Endovascular coiling ; Health care ; Health care costs ; Identification methods ; Matching ; Medicine and Health Sciences ; Neurosciences ; Neurosurgery ; Patient outcomes ; Patients ; Research and Analysis Methods ; Sex ; Standard deviation ; Subgroups</subject><ispartof>PloS one, 2020-06, Vol.15 (6), p.e0234478-e0234478</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Grandhi et al. 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Prior to PS matching, there were significant but minor differences in age (56.7±12.8 vs. 58.2±12.6 years, p = 0.004) and sex (male 16.6% vs. 24.4%, p<0.0001) for PED and non-PED, respectively, but no differences in CCI (p = 0.08), length of stay (p = 0.88), or rate of routine discharge (p = 0.21). All-cause readmission/emergency department reevaluation rates in the two cohorts were similar at 30, 90, and 180 days and 1 and 2 years. Our results identified a significantly lower retreatment rate for PEDs at all follow-up time points over a 2-year period (range: 0.9-8.1%) compared with non-PED treatments (range: 1.7-11.6%). These findings remained consistent after PS matching: all-cause readmission/reevaluation rates were significantly lower in patients treated with PED at 90 days, 180 days, 1 year, and 2 years (p<0.001). Although the initial treatment costs were higher for PED at time of treatment (p<0.001), cumulative follow-up emergency department visit and readmission costs (inclusive of patients with no readmission and/or no retreatment) were significantly lower for patients with initial PED relative to non-PED treatment at 2 years (p = 0.021). These results suggest that PEDs may potentially reduce downstream retreatment rates and costs. Further work is required to improve identification of patient subgroups that could benefit from PED over non-PED treatments both initially and during follow-up.</description><subject>Age</subject><subject>Analysis</subject><subject>Aneurysm</subject><subject>Aneurysms</subject><subject>Biology and Life Sciences</subject><subject>Cardiovascular system</subject><subject>Care and treatment</subject><subject>Cerebral aneurysm</subject><subject>Codes</subject><subject>Cohort analysis</subject><subject>Comorbidity</subject><subject>Costs</subject><subject>Demographic aspects</subject><subject>Embolization</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Endovascular coiling</subject><subject>Health care</subject><subject>Health care costs</subject><subject>Identification methods</subject><subject>Matching</subject><subject>Medicine and Health 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2-year aneurysm retreatment and costs among patients treated with flow diversion versus non-flow diversion embolization: A Premier Healthcare Database retrospective cohort study</title><author>Grandhi, Ramesh ; Karsy, Michael ; Taussky, Philipp ; Ricker, Christine Nichols ; Malhotra, Ajay</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c669t-8587db55f0b6db28737a78d692b329bf7439af5daf2ca204bf513c3232bc95763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Analysis</topic><topic>Aneurysm</topic><topic>Aneurysms</topic><topic>Biology and Life Sciences</topic><topic>Cardiovascular system</topic><topic>Care and treatment</topic><topic>Cerebral aneurysm</topic><topic>Codes</topic><topic>Cohort analysis</topic><topic>Comorbidity</topic><topic>Costs</topic><topic>Demographic aspects</topic><topic>Embolization</topic><topic>Emergency medical 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one</jtitle><date>2020-06-18</date><risdate>2020</risdate><volume>15</volume><issue>6</issue><spage>e0234478</spage><epage>e0234478</epage><pages>e0234478-e0234478</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The use of endovascular treatments, including Pipeline embolization devices (PEDs) and coiling approaches (non-PEDs), has played an increasingly important role in the treatment of intracranial aneurysms. Despite multiple studies evaluating PEDs, a real-world evaluation of follow-up outcomes and costs remains to be completed. The Premier Healthcare Database (PHD), 2010-2017, was queried to identify patients with unruptured intracranial aneurysms treated endovascularly. Rates of readmission, retreatment, and cost at the same hospital were compared between patients who underwent PED and non-PED endovascular treatments of their aneurysms. One-to-three (PED-to-non-PED) propensity score (PS) matching was performed to adjust for potential case selection bias into the PED cohort, with covariates including age group, sex, Charlson Comorbidity Index (CCI) group, payor, region, and randomized hospital identifier. A total of 679 patients underwent PED placement and 8432 had non-PED treatments. Prior to PS matching, there were significant but minor differences in age (56.7±12.8 vs. 58.2±12.6 years, p = 0.004) and sex (male 16.6% vs. 24.4%, p<0.0001) for PED and non-PED, respectively, but no differences in CCI (p = 0.08), length of stay (p = 0.88), or rate of routine discharge (p = 0.21). All-cause readmission/emergency department reevaluation rates in the two cohorts were similar at 30, 90, and 180 days and 1 and 2 years. Our results identified a significantly lower retreatment rate for PEDs at all follow-up time points over a 2-year period (range: 0.9-8.1%) compared with non-PED treatments (range: 1.7-11.6%). These findings remained consistent after PS matching: all-cause readmission/reevaluation rates were significantly lower in patients treated with PED at 90 days, 180 days, 1 year, and 2 years (p<0.001). Although the initial treatment costs were higher for PED at time of treatment (p<0.001), cumulative follow-up emergency department visit and readmission costs (inclusive of patients with no readmission and/or no retreatment) were significantly lower for patients with initial PED relative to non-PED treatment at 2 years (p = 0.021). These results suggest that PEDs may potentially reduce downstream retreatment rates and costs. Further work is required to improve identification of patient subgroups that could benefit from PED over non-PED treatments both initially and during follow-up.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>32555657</pmid><doi>10.1371/journal.pone.0234478</doi><tpages>e0234478</tpages><orcidid>https://orcid.org/0000-0001-9000-6083</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Analysis Aneurysm Aneurysms Biology and Life Sciences Cardiovascular system Care and treatment Cerebral aneurysm Codes Cohort analysis Comorbidity Costs Demographic aspects Embolization Emergency medical care Emergency medical services Endovascular coiling Health care Health care costs Identification methods Matching Medicine and Health Sciences Neurosciences Neurosurgery Patient outcomes Patients Research and Analysis Methods Sex Standard deviation Subgroups |
| title | Reduced 2-year aneurysm retreatment and costs among patients treated with flow diversion versus non-flow diversion embolization: A Premier Healthcare Database retrospective cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-19T15%3A47%3A42IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Reduced%202-year%20aneurysm%20retreatment%20and%20costs%20among%20patients%20treated%20with%20flow%20diversion%20versus%20non-flow%20diversion%20embolization:%20A%20Premier%20Healthcare%20Database%20retrospective%20cohort%20study&rft.jtitle=PloS%20one&rft.au=Grandhi,%20Ramesh&rft.date=2020-06-18&rft.volume=15&rft.issue=6&rft.spage=e0234478&rft.epage=e0234478&rft.pages=e0234478-e0234478&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0234478&rft_dat=%3Cgale_plos_%3EA626971422%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2414723097&rft_id=info:pmid/32555657&rft_galeid=A626971422&rft_doaj_id=oai_doaj_org_article_aa6e63082c344ca19e1b76cdde562327&rfr_iscdi=true |