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. 2020 Jan;162(1):169-173.
doi: 10.1007/s00701-019-04134-6. Epub 2019 Nov 23.

Cost determinants in management of brain arteriovenous malformations

Caleb Rutledge  1 , Jeffrey Nelson  2 , Alex Lu  3 , Peyton Nisson  4 , Soren Jonzzon  3 , Ethan A Winkler  3 , Daniel Cooke  5 , Adib A Abla  3 , Michael T Lawton  4 , Helen Kim  2
Affiliations

Cost determinants in management of brain arteriovenous malformations

Caleb Rutledge et al. Acta Neurochir (Wien). 2020 Jan.

Abstract

Introduction: There is little data on the cost of treating brain arteriovenous malformations (AVMs). The goal of this study then is to identify cost determinants in multimodal management of brain AVMs.

Methods: One hundred forty patients with brain AVMs prospectively enrolled in the UCSF brain AVM registry and treated between 2012 and 2015 were included in the study. Patient and AVM characteristics, treatment type, and length of stay and radiographic evidence of obliteration were collected from the registry. We then calculated the cost of all inpatient and outpatient encounters, interventions, and imaging attributable to the AVM. We used generalized linear models to test whether there was an association between patient and AVM characteristics, treatment type, and cost and length of stay. We tested whether the proportion of patients with radiographic evidence of obliteration differed between treatment modalities using Fisher's exact test.

Results: The overall median cost of treatment and interquartile range was $77,865 (49,566-107,448). Surgery with preoperative embolization was the costliest treatment at $91,948 (79,914-140,600), while radiosurgery was the least at $20,917 (13,915-35,583). In multi-predictor analyses, hemorrhage, Spetzler-Martin grade, and treatment type were significant predictors of cost. Patients who had surgery had significantly higher rates of obliteration compared with radiosurgery patients.

Conclusions: Hemorrhage, AVM grade, and treatment modality are significant cost determinants in AVM management. Surgery with preoperative embolization was the costliest treatment and radiosurgery the least; however, surgical cases had significantly higher rates of obliteration.

Keywords: Brain arteriovenous malformation; Cost; Cost-effectiveness.

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Conflict of interest statement

Conflict of Interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Figure 1.
Figure 1.
Time to AVM obliteration after radiosurgery
See this image and copyright information in PMC

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