Response to Letter by Schestatsky and Picon
The letter by Drs Schestatsky and Picon brings to light the economics of medical care that are difficult to generalize within a particular nation and impossible globally. Given the differences in techniques, types of coils, and size of aneurysms, there are no clear data on the “average number of coils needed for each procedure.” It is clear that the direct cost of consumables for the endovascular coiling of cerebral aneurysms exceeds that of clipping in the majority of procedures.1–3 However, it is questionable whether there is any difference in overall cost of treatment between the 2 modalities.1,2,4 Given the global variations in medical costs on multiple levels ranging from hospitalization costs, materials, physician reimbursement, medical liability, and so on, it would be impossible to generate recommendations based on cost analysis. The “Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Hear Association” sought to provide evidence-based management for the treatment of ruptured cerebral aneurysms.5 We sought to concentrate on the scientific and clinical evidence for treatment and management of aneurysmal subarachnoid hemorrhage. We are cognizant of the fact that ultimate treatment decisions are based on a multitude of variables: scientific and clinical evidence, social, and economic.
Hoh BL, Chi YY, Dermott MA, Lipori PJ, Lewis SB. The effect of coiling versus clipping of ruptured and unruptured cerebral aneurysms on length of stay, hospital cost, hospital reimbursement, and surgeon reimbursement at the University of Florida. Neurosurgery. 2009; 64: 614–619;discussion 619–621.
Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE Jr, Harbaugh RE, Patel AB, Rosenwasser RH; American Heart Association. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009; 40: 994–1025.