OBJECTIVES : To reduce bleeding risk during surgery, brain arteriovenous malformations (bAVMs) may be treated with liquid embolic systems (LES) such as the n-BCA (n-butyl cyanoacrylate) LES and the EVOH [(ethylene vinyl alcohol) copolymer dissolved in DMSO (dimethyl sulfoxide)] LES. To determine the procedure cost of embolization, technique and ancillary devices should be considered including specialized microcatheters developed to reduce complications. A cost-comparison analysis from a US healthcare-cost perspective was conducted to assess procedure costs using n-BCA or EVOH LES techniques.

METHODS : The analysis assumed a total of 4mL of liquid embolic was needed to treat 2 pedicles of a bAVM using four techniques. For the n-BCA technique, a 3:1 solution (3mL ethiodized oil/1ml n-BCA); 4mL total, 2mL of solution with 1 PROWLER10 microcatheter were used per pedicle. In the EVOH “Plug-and-Push” technique, 1 unit EVOH34, 2 units EVOH18 and 1 MARATHON microcatheter were used per pedicle. In the EVOH “Detachable-Tip” technique, 2 units EVOH18 and 1 APOLLO ONYX LES delivery microcatheter were used per pedicle. In the EVOH “Balloon-Assisted” technique, 2 units EVOH18 and 1 SCEPTER -XC balloon catheter were used per pedicle. Average selling price was used for devices.

RESULTS : The Plug-and-Push technique had the highest total device cost ($16,998; $15,616 for EVOH, $1,382 for microcatheters). Followed by the Detachable-Tip technique ($14,524; $10,536 for EVOH, $3,988 for microcatheters) and Balloon-Assisted technique ($13,592; $10,536 for EVOH, $3,056 for balloon microcatheters). The least costly was the n-BCA technique $5,834 ($3,942 for n-BCA, $1,892 for microcatheters). Total device costs were 2.3 to 2.9-times higher with EVOH LES techniques compared with n-BCA owing to the need for additional units of EVOH and ancillary devices.

CONCLUSIONS : This analysis illustrates that ancillary devices and number of LES kits impact procedure costs. The cost-sparing n-BCA technique for bAVM embolization may result in cost savings for US hospitals.