1090 Cost Effectiveness of Woven Endobridge Versus Stent-Assisted Coiling in Treatment of Wide Necked Aneurysms

INTRODUCTION: The Woven Endobridge (WEB) device has been shown to be a safe and effective alternative treatment option to stent-assisted coiling (SAC) for wide-necked intracranial aneurysms. METHODS: A retrospective review of patients from three tertiary care centers undergoing endovascular treatment of ruptured and unruptured wide-necked aneurysms with a focus on the cost of the devices, procedure time, fluoroscopy time and total radiation dose. We performed a cost effectiveness analysis comparing billing for all WEB devices opened versus WEB devices implanted. RESULTS: 73 WEB treated wide-necked aneurysms were location and size matched with 72 SAC treated aneurysms. Procedure and fluoroscopy time were significantly shorter in the WEB group. A trend towards lower radiation dose in the WEB group was observed. The average cost of the devices was significantly lower in the WEB group compared to the SAC group. Analysis of cost based on aneurysm diameter showed that the cost becomes significantly less in the WEB group once the aneurysm diameter reaches 9mm based on billing for all opened WEB devices. In an analysis of WEB versus SAC based on actual materials implanted, the WEB device becomes more cost efficient at 8.3 mm. A total of 3 SAC-treated aneurysm required retreatment, with one case of rupture. Two patients in the WEB group underwent re-treatment with flow-diversion. CONCLUSIONS: The average cost of WEB device cases is significantly lower than of SAC cases. There is cost equilibrium once the aneurysm diameter reaches 9 mm in a real-world scenario of billing for all opened WEB devices. Procedure and fluoroscopy time are significantly lower in the WEB group. As sizing of the WEB devices improves, WEB embolization is estimated to become more cost effective at and above 8.3mm.