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.
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References
Berman MF, Hartmann A, Mast H, Sciacca RR, Mohr JP, Pile-Spellman J, Young WL (1999) Determinants of resource utilization in the treatment of brain arteriovenous malformations. AJNR American journal of neuroradiology 20:2004–2008
Caruso JP, Moosa S, Fezeu F, Ramesh A, Sheehan JP (2015) A cost comparative study of Gamma Knife radiosurgery versus open surgery for intracranial pathology. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 22:184–188. https://doi.org/10.1016/j.jocn.2014.08.012
Davies JM, Yanamadala V, Lawton MT (2012) Comparative effectiveness of treatments for cerebral arteriovenous malformations: trends in nationwide outcomes from 2000 to 2009. Neurosurgical focus 33:E11. https://doi.org/10.3171/2012.5.focus12107
Kano H, Flickinger JC, Yang HC, Flannery TJ, Tonetti D, Niranjan A, Lunsford LD (2014) Stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations. Journal of neurosurgery 120:973–981. https://doi.org/10.3171/2013.12.jns131600
Kano H, Lunsford LD, Flickinger JC, Yang HC, Flannery TJ, Awan NR, Niranjan A, Novotny J Jr, Kondziolka D (2012) Stereotactic radiosurgery for arteriovenous malformations, Part 1: management of Spetzler-Martin grade I and II arteriovenous malformations. Journal of neurosurgery 116:11–20. https://doi.org/10.3171/2011.9.jns101740
Lunsford LD, Kondziolka D, Flickinger JC, Bissonette DJ, Jungreis CA, Maitz AH, Horton JA, Coffey RJ (1991) Stereotactic radiosurgery for arteriovenous malformations of the brain. Journal of neurosurgery 75:512–524. https://doi.org/10.3171/jns.1991.75.4.0512
Miller CE, Quayyum Z, McNamee P, Al-Shahi Salman R (2009) Economic burden of intracranial vascular malformations in adults: prospective population-based study. Stroke; a journal of cerebral circulation 40:1973–1979. https://doi.org/10.1161/strokeaha.108.539528
Morgan MK, Rochford AM, Tsahtsarlis A, Little N, Faulder KC (2004) Surgical risks associated with the management of grade I and II brain arteriovenous malformations. Neurosurgery 54:832–837 discussion 837-839
Morris Z, Whiteley WN, Longstreth WT Jr, Weber F, Lee YC, Tsushima Y, Alphs H, Ladd SC, Warlow C, Wardlaw JM, Al-Shahi Salman R (2009) Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ (Clinical research ed) 339:b3016. https://doi.org/10.1136/bmj.b3016
Porter PJ, Shin AY, Detsky AS, Lefaive L, Wallace MC (1997) Surgery versus stereotactic radiosurgery for small, operable cerebral arteriovenous malformations: a clinical and cost comparison. Neurosurgery 41:757–764 discussion 764-756
Potts MB, Lau D, Abla AA, Kim H, Young WL, Lawton MT (2015) Current surgical results with low-grade brain arteriovenous malformations. Journal of neurosurgery:1–9. https://doi.org/10.3171/2014.12.jns14938
Ruiz-Sandoval JL, Cantu C, Barinagarrementeria F (1999) Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis. Stroke; a journal of cerebral circulation 30:537–541
Steiner L, Lindquist C, Adler JR, Torner JC, Alves W, Steiner M (1992) Clinical outcome of radiosurgery for cerebral arteriovenous malformations. Journal of neurosurgery 77:1–8. https://doi.org/10.3171/jns.1992.77.1.0001
van Rooij WJ, Jacobs S, Sluzewski M, van der Pol B, Beute GN, Sprengers ME (2012) Curative embolization of brain arteriovenous malformations with onyx: patient selection, embolization technique, and results. AJNR American journal of neuroradiology 33:1299–1304. https://doi.org/10.3174/ajnr.A2947
Wellis G, Nagel R, Vollmar C, Steiger HJ (2003) Direct costs of microsurgical management of radiosurgically amenable intracranial pathology in Germany: an analysis of meningiomas, acoustic neuromas, metastases and arteriovenous malformations of less than 3 cm in diameter. Acta neurochirurgica 145:249–255. https://doi.org/10.1007/s00701-003-0007-4
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This article is part of the Topical Collection on Vascular Neurosurgery - Arteriovenous malformation
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Rutledge, C., Nelson, J., Lu, A. et al. Cost determinants in management of brain arteriovenous malformations. Acta Neurochir 162, 169–173 (2020). https://doi.org/10.1007/s00701-019-04134-6
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DOI: https://doi.org/10.1007/s00701-019-04134-6