Improved healthcare utilization and economic outcomes of chronic subdural hematoma treatment with middle meningeal artery embolization compared to conventional surgical drainage.

Background: Middle meningeal artery embolization (MMAE) emerges as an alternative to conventional surgical drainage (CSD) for chronic subdural hematomas (cSDH). Several studies have suggested that MMAE improves the cost efficacy of cSDH treatment. However, further comprehensive analyses of the outcomes and healthcare costs of MMAE are necessary.

Methods: Merative MarketScan Research Database from 2017-2022 was used to compare demographics, reoperation rates, complications, healthcare utilization, and payments of patients being treated with CSD, CSD and adjunctive MMAE, or standalone MMAE for cSDH or nontraumatic subdural hemorrhage.

Results: From 2017-2022, there were 2108 patients who underwent CSD (n = 2015), or CSD+MMAE (n = 23) or MMAE only (n = 70). The median age of the surgical group was 61 years (IQR 53-73 years), the surgery plus MMAE was 67 years (56-77 years) and the MMAE group was 65 years (55-77 years). Median hospital days were significantly longer for the CSD (6 (IQR 5-7) days) and CSD + MMAE (7 (IQR 6-7) days) groups compared to MMAE only (0 days(IQR 0-1)(p < 0.0001). Median index hospitalization payments were significantly higher for the CSD+MMAE group ($74,568) compared to both CSD ($39,658) (p = 0.003) and MMAE groups ($22,286) (p < 0.0001). The total median payments at six-month follow-up for the CSD group were higher compared to CSD+MMAE ($11494 vs $7300, p = 0.0017) but not compared to MMAE only ($10,680, p = 0.08).

Conclusions: The reduced complications, infection rate, hospital utilization, and costs observed in this study support MMAE as a promising treatment option in the arsenal for cSDH management.