1361 The Tipping Point in Middle Meningeal Artery Embolization: An Algorithm-Based Cost Effectiveness Analysis

INTRODUCTION: The addition of middle meningeal artery embolization (MMAE) to surgery has been shown to decrease chronic subdural hematoma (cSDH) recurrence and improve outcomes. METHODS: We retrospectively reviewed 41 patients that had been previously randomized to either surgery only (control) or surgery + MMAE (study) in the treatment of their symptomatic cSDH. We analyzed and compared all charges associated with their hospitalizations and treatments to generate an algorithm for management guidance. RESULTS: The groups were comparable in terms of demographics and cSDH characteristics. We reviewed 21 patients in the control group (27 admissions) and 20 patients in the study group (20 admissions). As expected, the average total charges for index admission were lower in the control group (US$158,320 vs 235,263, p = .037). Interestingly, no differences were observed when averaged per patient, rather than admission, between the two groups (US$203,554 vs 235,263, p = .25). The algorithm showed a Tipping Point for our institution of 20.8%. CONCLUSIONS: MMAE can be considered as an adjunct to surgery in the treatment of symptomatic cSDH to decrease overall cost by lowering rates of readmission and repeat intervention. The Tipping Point in MMAE can be a useful guide to determine the appropriate treatment options for symptomatic cSDH according to institutional or national standards. Findings support use of MMAE during index admission when recurrence rates >20.8%, at our institution.