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

Mira Salih; MirHojjat Khorasanizadeh; Nadia McMillan; Santiago Gomez-Paz; Ajith J Thomas; Christopher S Ogilvy; Justin M Moore

doi:10.1016/j.wneu.2022.12.042

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

World Neurosurg. 2023 Apr:172:e94-e99. doi: 10.1016/j.wneu.2022.12.042. Epub 2022 Dec 20.

Authors

Mira Salih¹, MirHojjat Khorasanizadeh¹, Nadia McMillan¹, Santiago Gomez-Paz¹, Ajith J Thomas¹, Christopher S Ogilvy¹, Justin M Moore²

Affiliations

¹ Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
² Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: jmoore4@bidmc.harvard.edu.

PMID: 36549437
DOI: 10.1016/j.wneu.2022.12.042

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Chronic subdural hematoma; Cost comparison; Middle meningeal artery embolization; Open surgery; Propensity score–matched analysis.

MeSH terms

Costs and Cost Analysis
Embolization, Therapeutic* / methods
Hematoma, Subdural, Chronic* / etiology
Hematoma, Subdural, Chronic* / surgery
Humans
Meningeal Arteries / surgery
Propensity Score