Cost Comparison for Open Surgery versus Middle Meningeal Artery Embolization in Patients with Chronic Subdural Hematomas: A Propensity Score–Matched Analysis

• Published in: World neurosurgery Vol. 172; pp. e94 - e99
• Main Authors: Salih, Mira, Khorasanizadeh, MirHojjat, McMillan, Nadia, Gomez-Paz, Santiago, Thomas, Ajith J., Ogilvy, Christopher S., Moore, Justin M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2023
• Subjects: Chronic subdural hematoma; Cost comparison; Costs and Cost Analysis; Embolization, Therapeutic - methods; Hematoma, Subdural, Chronic - etiology; Hematoma, Subdural, Chronic - surgery; Humans; Meningeal Arteries - surgery; Middle meningeal artery embolization; Open surgery; Propensity Score; Propensity score–matched analysis; MMAE; Chronic subdural hematoma; Propensity score–matched analysis; PACU; Middle meningeal artery embolization; cSDH; ICU; PSM; Open surgery; Cost comparison; mRS
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2022.12.042

Chronic subdural hematoma (cSDH) can be treated with conventional surgery or middle meningeal artery embolization (MMAE). The cost profiles of open surgery versus MMAE have never been studied. Therefore, we sought to compare the costs of surgical and MMAE treatment of cSDH. Patients treated with open surgery (2006–2019) and MMAE (2018–2020) were identified from the institutional database. Propensity score matching analysis was used to assemble a balanced group of subjects. Detailed hospitalization costs in each group were collected and compared. A total of 341 conventionally treated and 52 MMAE cases were identified. After propensity score matching, 33 patients were included in each group, for a total of 66 patients for analysis. Direct procedural cost was significantly greater in the MMAE group compared with the open surgery group ($38,255 ± $11,859 vs. $11,206 ± $7888; P < 0.001). Medication cost also was greater in the MMAE group ($6888 ± $6525 vs. $4291 ± $3547; P = 0.048). No significant difference was found in costs for intensive care unit care, pharmacy, therapy, laboratory values, and the emergency department. Imaging costs and other miscellaneous costs (e.g., wound care, preoperative, and postanesthesia care unit) were greater in the open surgery group (P < 0.05). Total hospitalization cost was not significantly different between the 2 groups ($60,598 ± 61,315 vs. $71,569 ± $37,813 for open surgery and MMAE respectively, P = 0.385). No significant differences in number of follow ups or total costs for follow up were found (P > 0.05). Open surgery and MMAE offer an overall equivalent cost-profile for cSDH treatment when matching for potential cost confounders. Direct procedural costs are greater in MMAE; however, total hospitalization costs and follow up costs are not significantly different.