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Intraoperative cerebral blood flow measurement prompts repositioning of aneurysm clips in 30%1 to 33%2 of aneurysm cases. Suboptimal clipping of aneurysms leads to rehemorrhage and/or mass effects and require reoperation in 42% of patients.2 The following cost savings analysis combines these findings with the assumption that
C-FAST (Charbel - Flow Assisted Surgical Technique) allows the surgeon to reduce post-op complication in 13.2% of all aneurysm patients (42% of 31.5%). This yields substantive economic benefits for patients,
hospitals, third party payers and society at large.
Primary Beneficiary — The Patient
Intraoperative stroke is devastating. Patients who undergo surgery with a "Thank goodness, my doctor diagnosed this condition in
time," attitude suddenly face a long and tedious road to recovery. The impact on a patient's family is equally devastating; from one day to the next, their role can
change from companion to caretaker.
Many stroke victims are at the peak of their income-producing career. US Government statistics3 report the total USA cost of lost productivity due to stroke (i.e., lost family income) is $13 billion per year. The family also must pay for many non-reimbursed medical expenses.
Secondary Beneficiary — The Hospital
An intra/post-operative stroke triggers a host of procedures (post-op angiography @$3,6242, cat-scans @$300-600, blood tests, EEG),
sometimes, a reoperation (¥$3,200 per hour for the OR, plus ancillary costs), longer hospital stays ($700 per day) and initial in-hospital rehabilitation. Under the
current cost reimbursement structure, most payers will not issue additional reimbursement for these hospital procedures: by preventing intra/post-op strokes the hospital
can save this money.
Presently, the prime approach for preventing these complications is intraoperative angiography which typically takes 45-60 minutes of OR time
and costs $4,025.2 In many instances, C-FAST can replace angiography; C-FAST typically takes 5 minutes of OR time and costs around $710.4
Conclusion #1
For
hospitals which currently perform intraoperative angiography, C-FAST reduces hospital costs:
- approximately $3,315 per surgery
- about $ 0.31 million per year for a 100/year surgical case load
For hospitals without an intraoperative clip placement monitoring program, cost savings are achieved by eliminating post-operative strokes.
Such cost savings, quantified in a Stanford University study on aneurysm surgery.5
Conclusion #2
By implementing C-FAST, a hospital typically reduces operating expenses:
- over $1,300 per aneurysm surgery
- about $ 134,000 per year for a 100-patient/year surgical case load
Third Beneficiary — Third Party Players
The same Stanford University study5 estimates follow-up medical costs for stroke victims: long-term nursing home care ($3083/mo for an
average of 5 years) and outpatient rehabilitation ($101/mo for an average of 6 months). By implementing Charbel Flow-based Aneurysm Surgery the hospital contains these
costs, as estimated in Table 2.
Conclusion #3
By implementing C-FAST, a hospital also contributes to medical cost containment:
- about $3,680 per aneurysm surgery
- about $ 0.37 million per year for a 100-patient/year surgical case load
References
- Charbel, F.T., Gonzales-Portillo,
G., Du, X., Ostergren, L.A., "Clip Related Vessel Flow Compromise in Aneurysm Surgery," Joint Section on Cerebrovascular Surgery at AANS/CNS, 1999.
- Origitano, T.C., Schwartz, K., Anderson, D.,
Azar-Kia, B., Reichman, O.H., "Optimal Clip Application and Intraoperative Angiography for Intracranial Aneurysms," Surgical Neurology, Vol. 51, p. 117-128,
1999.
- NIH, National Institute of Neurological & Stroke Statistics
- Annual Flow-QC Operating Expenses:
1.5 flow probes per aneurysm case @ $440 ea, plus $5,000/year in flowmeter depreciation and maintenance. For 100 cases/year, per surgery cost would be $710.
- Chang, S.D., Lopez, J.R., Steinberg, G.K., "A
Cost-benefit Analysis of the Use of Electrophysiologic Monitoring during Intracranial Aneurysm Surgery," 48th Annual Meeting of the Congress of Neurological
Surgeons, Seattle, WA, October 3-8, 1998.
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