Cost comparison of endovascular treatment of anterior circulation aneurysms with the pipeline embolization device and stent-assisted coiling

BACKGROUND: The Pipeline embolization device (PED) is a new endovascular option for wide-necked or fusiform anterior circulation aneurysms that were classically treated by coil embolization with adjunctive use of a stent. However, stent-coiling incurs significant equipment and implant costs. OBJECTIVE: To determine whether PED embolization is more economical than stent-assisted coiling. METHODS: Sixty consecutive patients with anterior circulation aneurysms who underwent treatment with the PED (30 patients) or by single-stage stent-assisted coiling (30 patients) were identified from a prospective single-center aneurysm database. The hospital costs of equipment and implants were analyzed and compared for each group. RESULTS: The mean aneurysm size for patients treated with the PED was 9.8 vs 7.3 mm for patients treated by stent-assisted coiling. The total combined costs of proximal access/guide catheters, microcatheters, and microwires were equivalent between the 2 groups. The cost of implants, however, was significantly lower in the PED group ($13175 ± 726 vs $19069 ± 2015; P =.013), despite this group having a larger mean aneurysm size. Furthermore, the total procedure cost was significantly lower for the PED group vs the stent-coiling group ($16445 ± 735 vs $22145 ± 2022; P =.02), a 25.7% cost reduction. This represents a 27.1% reduction in the cost per millimeter of aneurysm treated in the PED group ($2261 ± 299) vs the stent-coiling group ($3102 ± 193; P =.02). CONCLUSION: Treatment of anterior circulation aneurysms by flow diversion with the PED has lower procedure costs compared with treatment with traditional stent-assisted coiling.