Tipping point in middle meningeal artery embolization: a cost-effectiveness and algorithm-based analysis

Area of Science:

• Neurosurgery
• Interventional Radiology
• Health Economics

Background:

• Chronic subdural hematoma (cSDH) is a common neurosurgical condition.
• Surgical evacuation is the traditional treatment, but middle meningeal artery (MMA) embolization is emerging as an effective adjunct.
• Healthcare resource constraints necessitate cost-effective treatment strategies.

Purpose of the Study:

• To compare the cost-effectiveness of surgery alone versus surgery plus MMA embolization for cSDH.
• To calculate an institutional tipping point for the cost-benefit of adding MMA embolization.

Main Methods:

• Retrospective analysis of 41 patients with symptomatic cSDH from May 2019 to December 2022.
• Categorization and assessment of all treatment-related charges from admission to last follow-up.
• Calculation of the institutional tipping point for MMA embolization addition.

Main Results:

• The surgery-only group had a lower mean cost for the index admission (US$158,320 vs $235,263).
• No significant differences in overall mean costs per patient were observed between groups ($203,554 vs $235,263).
• The institutional tipping point for adding MMA embolization was determined to be 20.8%.

Conclusions:

• MMA embolization can be a valuable adjunct to surgery for symptomatic cSDH, potentially reducing readmission and repeat intervention costs.
• The calculated tipping point provides a versatile guide for institutional decision-making on treatment options.
• This approach aids in balancing patient care with cost-conscious resource allocation.