Cost comparison of liquid versus particulate embolic agents for middle meningeal artery embolization in chronic subdural hematoma

IntroductionChronic subdural hematomas (cSDH) are increasingly recognized as a major cause of morbidity in aging populations. Procedural Innovations such as middle meningeal artery embolization (MMAE) are becoming more widely adopted for cSDH treatment. While embolization reduces hematoma recurrence, the economic cost of different embolic agents remains unclear. This study evaluates inpatient procedural costs associated with particulate versus liquid embolic materials in MMAE for cSDH.MethodsA retrospective cohort study was conducted at a Comprehensive Stroke Center, including patients who underwent MMAE for cSDH between January 2019 and January 2024. Actual hospital expenditure data was used to assess total procedural and material-specific costs. Clinical outcomes, such as modified Rankin Scale (mRS) scores and 90-day retreatment rates, were compared between embolic agent groups. The primary independent variable was the embolic agent, categorized as particulate or liquid embolics (liquid including Onyx and nBCA).Results114 patients were included, with 18 (15.8%) treated with liquid embolics and 96 (84.2%) treated with particulate embolization. Baseline demographics and procedural variables were largely similar across groups. Procedural costs trended higher for liquid embolization than particulates ($27,419.50 ± $15,851.84 vs. $24,731.24 ± $23,195.37, p = 0.639). Material-specific costs were substantially greater for liquid ($3703.17 ± $1797.85) than to particulates ($152.74 ± $75.91, p < 0.0001). Functional outcomes (mRS at discharge, 30 days, and 90 days) and 90-day retreatment rates were not significantly different between groups. Subgroup analyses of hospital costs and access site also showed no significant differences.ConclusionsParticulate embolic agents offer a cost-effective alternative to liquid embolics for MMAE in cSDH, achieving comparable clinical outcomes at a significantly reduced material cost. Cost-conscious embolic selection may help sustain procedural expansion as MMAE adoption grows.