(159) Readmission Rates and Costs Associated with the Use of Enterprise 2 and Neuroform Atlas Stents for Unruptured Intracranial Aneurysms: A Comparative Real-World Analysis

Background: Stent-assisted endovascular coiling is an effective treatment for wide-necked unruptured intracranial aneurysms (UIA).

Objectives: This study aims to examine differences in 180-day inpatient readmissions and index admission costs among UIA patients treated with the closed cell ENTERPRISE® 2 stent versus the open cell Neuroform® Atlas stent during endovascular stent assisted coiling (SAC) procedures.

Methods: Using the 2015-2022 Premier Healthcare Database® (PHD), a U.S. nationwide hospital database, UIA patients aged ≥18 years undergoing SAC procedures were identified. Based on the stent used, patients were classified into two cohorts: ENTERPRISE®2 or Neuroform® Atlas. Study outcomes including 180-day all-cause and UIA-related inpatient readmissions, and index admission cost and index admission supply cost were assessed. Inverse probability of treatment weighting was used to balance the two study cohorts on covariates including patient demographic, comorbidity, and hospital characteristics. A weighted generalized estimating equation (GEE) model (logit link and binomial distribution function) was used to examine differential in readmission outcomes among study cohorts.

Results: Based on study criteria, 1,017 patients were identified with 126 in the ENTERPRISE® 2 cohort and 891 in the Neuroform® Atlas cohort. Patient characteristics were well balanced after weighting with 57.2% vs 62.1% of patients ≥age 60, and 30.5% vs 27.8% males for ENTERPRISE®2 and Neuroform® Atlas cohorts respectively. Patients undergoing SAC using ENTERPRISE® 2 had significantly lower rates of 180-day all-cause inpatient readmissions compared to those treated with Neuroform® Atlas (7.4% vs 15.6%, p=0.03; odds ratio [OR] 0.45, confidence interval [CI] 0.20-0.98, p=0.04). No significant difference in 180-day UIA-related inpatient readmissions was observed among ENTERPRISE® 2 vs Neuroform® Atlas (2.7% vs. 6.5%, p=0.11; OR 0.39, 95% CI 0.12-1.26, p=0.12).
Patients treated with ENTERPRISE®2 incurred lower procedural supply costs vs Neuroform® Atlas ($20,442 vs $27,561, p=0.006; exponential ratio [ER] 0.74, 95% CI 0.61-0.90, p=0.002) while no significant difference was found in the index admission costs for ENTERPRISE® 2 vs Neuroform® Atlas patients ($39,729 vs $44,650, p=0.31, ER 0.91 CI 0.76-1.09, p=0.29).

Conclusions: Among patients undergoing stent-assisted endovascular coiling, those treated with the closed cell ENTERPRISE®2 stent were observed to have significantly lower risk of all-cause readmissions and lower supply costs at the index procedure compared to the open cell Neuroform® Atlas stent.