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Nancy A. Obuchowski, Michael T. Modic and Michele Magdinec

of asymptomatic patients for intracranial aneurysms incurs two types of costs: the cost of the diagnostic test and the cost of treatment. At our institution the direct cost of a noninvasive diagnostic test such as MR angiography is approximately $750. Furthermore, a positive MR angiography study at our institution is usually followed by an angiogram with a cost of $1000. There are two costs associated with the treatment of intracranial aneurysms detected by screening. First, there is the differential cost of treating a patient with aneurysmal SAH versus treating

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in medical advances. These resources include patients, money, time, talents, and opportunities for investigation and discovery. The explosive growth of health management organizations is causing a reconstruction of referral bases and channels and, in doing so, deprives academic medical centers of the very element vital to their existence—patients. Reduced reimbursements, which are calculated in terms of “direct cost” without consideration for the “indirect cost,” are depleting the surplus funds used to cover research, education, or care of the indigent population

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Alberto Maud, Kamakshi Lakshminarayan, M. Fareed K. Suri, Gabriela Vazquez, Giuseppe Lanzino and Adnan I. Qureshi

Price Index. Cost of Cerebral Angiography The direct cost of each cerebral angiogram was taken from nationally representative data (ICD-9-CM code 88.41) and previous studies. 8 , 12 Cost of Additional Treatment Because the vast majority of patients who underwent retreatment in the ISAT had not experienced aneurysm rupture, the cost of retreatment was extrapolated from the cost of treatment of an unruptured intracranial aneurysm. The cost of the treatment for unruptured aneurysm was extracted from the Premier Perspective Comparative Database. 12 Patients

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Luis M. Tumialán, Ryan P. Ponton and Wayne M. Gluf

PCF group was excluded from data analysis because he did not return to unrestricted full duty ( Table 1 ). Direct cost consisted of institutional and instrumentation costs. The institutional costs were $3096 in the PCF group and $5999 in the ACDF group, a difference of $2903. Average instrumentation costs were $474 in the PCF group and $4079 in the ACDF group, a difference of $3605. (The 12 minimally invasive PCF cases also had a rental fee of $750 per case.) The total difference in direct cost between the 2 procedures was $6508 ( Table 2 ). TABLE 2

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Editorial

Treatment options for lumbar spinal stenosis

Michael G. Fehlings and Soo Yong Chua

laminectomy and suggested that use of the X-STOP device for the treatment of LSS is clinically at least as effective as standard laminectomy at 4 years postoperatively and provides substantial direct cost savings compared with decompressive surgery. In the article in this issue, Burnett et al. 1 conducted an in-depth systematic review of the literature related to LSS, which included both surgical and nonsurgical approaches. They gathered information based on 3 treatment arms—nonsurgical management, laminectomy, and X-STOP. Because of the diversity of measurements used by

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-laminectomy for lumbar stenosis associated radiculopathy after 6 months of conservative therapy were included. Over a two-year period, total back-related medical resource utilization, missed work, and improvement in pain (VAS-LP), disability (Oswestry Disability Index (ODI), quality of life (SF-12), and health-state values [quality adjusted life years (QALYs), calculated from EQ-5D with U.S. valuation] were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and patient and care-giver work-day losses

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Matthew J. McGirt, Scott L. Parker, Jason Lerner, Luella Engelhart, Tyler Knight and Michael Y. Wang

score category 1 1.309 (0.903–1.897) CCI score category 2 2.081 (1.063–4.072) CCI score category ≥3 3.553 (0.981–12.861) * Reference groups are MI cohort, increasing age, rural hospitals, and CCI Score 0. Direct Costs Associated With SSI The total direct cost associated with the diagnosis and management of the 292 SSIs identified in this study was $4,618,812 (MI $1,024,950 vs open $3,593,862), resulting in an overall mean direct cost of $15,817 per SSI. For 1-level fusion, the mean SSI-associated cost per P/TLIF was similar between MI and open

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Julie Dubourg and Mahmoud Messerer

N ontraumatic intracerebral hemorrhage constitutes a major public health problem worldwide, accounting for 2 million (10%–15%) 81 of about 15 million strokes worldwide each year. 60 In the US, on average, someone has a stroke every 40 seconds. 60 Its direct cost is around US$12.7 billion of the US$73.7 billion related to stroke care annually. 60 Despite active research, it is still the least treatable cause of stroke and a leading cause of morbidity, disability, and death worldwide. 75 During the first month after ICH onset, the proportion of patients

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Owoicho Adogwa, Scott L. Parker, Brandon J. Davis, Oran Aaronson, Clinton Devin, Joseph S. Cheng and Matthew J. McGirt

fusion procedures. In 2000 and 2004, the initial cost-effectiveness studies on lumbar fusion used economic modeling and direct cost comparisons in heterogeneous patient populations to demonstrate that instrumented lumbar fusion may not be cost-effective. 8 , 13 In 2008, Tosteson et al. 15 performed the first formal cost-utility analysis on “as-treated” cohorts from the prospective randomized SPORT and demonstrated that lumbar fusion was not very cost-effective when compared with medical management at 2 years ($115,600/QALY gained). However, the fusion cohort

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Scott L. Parker, William N. Anderson, Sean Lilienfeld, J. Thomas Megerian and Matthew J. McGirt

and non-AIS cohorts (1.4% vs 1.6%, p = 1.0). Furthermore, this review demonstrated a similar overall incidence of gram-negative infectious organisms between AIS and non-AIS catheters (11% vs 9%, p = 0.52), demonstrating that AIS catheters do not predispose to infections by pathogens that are not covered by the locally released antibiotics. Additionally, long-term implantation of AIS catheters has been shown to be safe, with no additional risk of seizures or drug resistance, as is seen with the long-term use of systemic antibiotics. 1 , 35 The initial direct cost