Cost determinants in management of brain arteriovenous malformations

Research output: Contribution to journalArticle

Authors

  • Caleb Rutledge
  • Jeffrey Nelson
  • Alex Lu
  • Peyton Nisson
  • Soren Jonzzon
  • Ethan A. Winkler
  • Daniel Cooke
  • Adib A. Abla
  • Michael T. Lawton
  • Helen Kim

External Institution(s)

  • University of California at San Francisco
  • St. Joseph's Hospital and Medical Center

Details

Original languageEnglish (US)
Pages (from-to)169-173
Number of pages5
JournalActa neurochirurgica
Volume162
Issue number1
StatusPublished - Jan 1 2020
Peer-reviewedYes

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.

    Research areas

  • Brain arteriovenous malformation, Cost, Cost-effectiveness

Citation formats

APA

Rutledge, C., Nelson, J., Lu, A., Nisson, P., Jonzzon, S., Winkler, E. A., ... Kim, H. (2020). Cost determinants in management of brain arteriovenous malformations. Acta neurochirurgica, 162(1), 169-173. https://doi.org/10.1007/s00701-019-04134-6

Harvard

Rutledge, C, Nelson, J, Lu, A, Nisson, P, Jonzzon, S, Winkler, EA, Cooke, D, Abla, AA, Lawton, MT & Kim, H 2020, 'Cost determinants in management of brain arteriovenous malformations', Acta neurochirurgica, vol. 162, no. 1, pp. 169-173. https://doi.org/10.1007/s00701-019-04134-6