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

Luca H Debs, Scott Y Rahimi, Fernando L Vale

    Neurosurgical Focus
    |October 1, 2025
    PubMed
    Summary

    Middle meningeal artery (MMA) embolization can reduce readmissions and repeat interventions for chronic subdural hematoma (cSDH), potentially lowering overall costs. This study determined an institutional tipping point for when adding MMA embolization becomes cost-beneficial.

    Keywords:
    algorithmcost-effectivenessmiddle meningeal artery embolizationsubdural hematomatipping point

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    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.