Costing Interventional Neuroradiology Procedures

South Eastern Sydney Local Health District, 2013

Interventional neuroradiology (INR) includes a range of procedures for the endovascular treatment of conditions of the brain and spine such as subarachnoid haemorrhage (SAH), unruptured intracranial aneurysms (UIAs) management of vasospasm following SAH, and a range of other conditions such as arteriovenous malformations (AVM), acute ischaemic stroke conditions, brain tumours and spinal fractures. INR procedures frequently involve the use of stents, angioplasty, coils, glues, cement, devices to deliver chemical treatments directly to the site of a vasospasm or an ischaemic stroke stenosis/thrombus, and devices to mechanically extract a thrombus.

These procedures are emerging as an important, but specialised, component of services required to address these conditions

Health Policy Analysis was engaged by South Eastern Sydney Local Health District (on behalf of the NSW State Planning Group) to conduct a study of the costs of these procedures, as provided in NSW public hospitals, and project activity for these services. This information was used to evaluate options for future arrangements for INR services in NSW public hospitals.

Health Policy Analysis undertook a micro-costing study of INR procedures in four NSW public hospitals. This involved gathering data from clinicians (INR specialists, neurosurgeons, intensive care specialists, nursing staff, business managers) about the resources used in the delivery of these services that is not captured in routine information systems. This information was combined with that from routine information systems (e.g. annual costing studies undertaken by the hospitals) to estimate costs for individual INR procedures. Costs were also estimated for more 'traditional' approaches to treating patients with INR amenable conditions for comparison purposes.

In addition to the costing study, Health Policy Analysis undertook projections of INR activity, using learnings from the literature and opinions of clinical experts, and applying these to known characteristics of the NSW population (e.g. ageing, morbidity in specific areas).