Presentation (CTI)

OBJECTIVES: Chronic subdural hematoma (cSDH) is associated with high recurrence and substantial healthcare resource utilization. Middle meningeal artery embolization (MMAE) is increasingly adopted, with different embolic agents available. This analysis assessed the budget impact of liquid embolic agents versus particles from a National Healthcare System perspective, focusing on reintervention related costs and resource use.
METHODS: A budget impact framework was developed to estimate costs associated with reinterventions following MMAE in a cohort of 100 patients. Reintervention was defined as surgical evacuation requiring a new hospital admission. Literature-based reintervention rates were assumed to range from 3 to 7% for liquid embolic agents and 5 to 10% for particles. Each reintervention, typically requiring surgical evacuation, was associated with average hospital stay of approximately 6 days. Italian Diagnosis-Related Group (DRG) tariff (approximately €11,800 per admission) was used as a proxy for hospitalization costs.
RESULTS: Available evidence suggests a trend toward lower reintervention rates with liquid embolics, although results vary across studies. In a cohort of 100 patients, this corresponds to an absolute risk reduction of approximately 2 to 3%, translating into 2 to 3 fewer reinterventions when liquid embolic agents are used. Assuming a cost of approximately €11,800 per reintervention, this results in estimated cost savings of €24,000 to €35,000 per 100 patients (€240 to €350 per patient). Each avoided surgical reintervention corresponds to approximately 6 hospital days avoided, resulting in 12-18 hospital days saved per 100 patients. Overall, costs are primarily driven by downstream events such as reinterventions and related hospitalizations.
CONCLUSIONS: From National Healthcare System perspective, embolic agent choice in MMAE may have economic implications driven by downstream resource use; liquid embolic agents may contribute to cost offsets by reducing reinterventions and associated hospitalizations. These findings highlight the importance of adopting a full care pathway perspective in the economic evaluation of embolization strategies for cSDH.