Abstract
This research had two major objectives: 1) to determine incidence, access to treatment and clinical outcomes of patients with cerebral aneurysm who received clipping or coiling procedures; and 2) to examine whether coiling instrument should be included in the reimbursable list of beneficial package for patients under the Universal Coverage Scheme. Although coiling procedure has been performed worldwide, a slightly increasing rate of patients receiving coiling procedure in Thailand was observed during 2012-2018. In addition, increasing rate of patients under the Universal Coverage Scheme receiving clipping was significantly higher than that of those receiving coiling. Since the year 2012, survival rate among patients undertaking clipping was higher than the rate in 2006-2011. This finding did not support the hypothesis that patients receiving clipping had poorer prognosis than those receiving coiling or clipping was performed only in those who were not candidate to coiling. Survival rate of patients receiving clipping in the university hospitals was higher than those in the Ministry of Public Health (MOPH) hospitals and non-MOPH hospitals. Survival rate in hospitals with high volume of intervention (clipping or coiling >30 cases/year) was higher than the hospitals with low volume of intervention. Access to treatment and clinical outcomes varied across the health regions. Collaboration among the health regions to improve referral system for enhancing the service efficiency and patient outcomes should be addressed. Planning for neurosurgery or radiology manpower who have a specialized training for endovascular coiling should be considered, especially in the university hospitals. Based on the societal perspective, incremental cost effectiveness ratio (ICER) of coiling as compared to clipping was cost saving. Therefore, coiling instrument should be included in the reimbursable list of beneficial package for patients under the Universal Coverage Scheme.
