Post-Doctoral Neurosurgery Research Fellow Johns Hopkins University
Introduction: Chronic subdural hematoma (cSDH) poses a growing challenge to healthcare systems. This study compares the cost-effectiveness of craniotomy, MMA embolization (MMAE), and a combined approach, focusing on healthcare costs and discharge outcomes to guide economically sustainable treatment decisions for cSDH.
Methods: We identified patients with cSDH from the national inpatient sample (NIS) database, categorizing them into: craniotomy, MMAE, and combined. We collected demographic and clinical data. Trend analysis from 2017–2020 examined treatment utilization and associated changes in length of stay (LOS), mortality rates, and costs. Cost-effectiveness analysis was conducted by calculating the Incremental Cost-Effectiveness Ratio (ICER) for each treatment, with home discharge rates as the primary outcome. A ±20% sensitivity analysis assessed the robustness of the ICER results.
Results: Among 5,754 patients treated for cSDH, 4,872 underwent craniotomy, 726 received MMAE, and 156 received both. MMAE increased from 15% in 2017 to nearly 40% by 2020, with LOS decreasing from 14 to 11 days and mortality falling below 10%. Craniotomy had the lowest mean cost ($157,612) and the lowest home discharge rate (33.97%). MMAE achieved a higher discharge rate (40.22%) but was costlier ($261,923). The combined approach, costing $358,515, achieved a modest discharge rate of 35.90%. ICER analysis revealed that MMAE required an additional $1,669 per home discharge. However, the combination approach was both less costly and more effective than MMAE alone, with a negative ICER of -$2,234.39. Sensitivity analysis confirmed these findings.
Conclusion : MMAE improves discharge outcomes but at a higher cost per additional home discharge compared to craniotomy. The combination of MMAE and craniotomy, though more costly overall, is the most cost-effective option when directly compared to MMAE alone, offering better outcomes at a reduced cost. These findings underscore the importance of balancing clinical outcomes with economic considerations to optimize resource utilization.
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