Cost-Effectiveness of Adjunctive Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Secondary Analysis of EMBOLISE.
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Findlay Matthew C, Gandhoke Gurpreet S, Davies Jason M, Knopman Jared, Smith Kenneth J, Mokin Maxim, Hassan Ameer E, Harbaugh Robert E, Khalessi Alexander, Fiehler Jens, Gross Bradley A, Tarpley Jason W, Sivakumar Walavan, Bain Mark, Crowley R Webster, Link Thomas W, Fraser Justin F, Levitt Michael R, Chen Peng Roc, Hanel Ricardo A, Bernard Joe D, Jumaa Mouhammad, Youssef Patrick, Cress Marshall C, Chaudry Mohammad Imran, Shakir Hakeem J, Lesley Walter S, Billingsley Joshua, Jones Jesse G, Koch Matthew J, Paul Alexandra R, Mack William J, Osbun Joshua W, Dlouhy Kathleen, Grossberg Jonathan A, Kellner Christopher P, Sahlein Daniel H, Santarelli Justin, Schirmer Clemens M, Liu Jesse J, Majjhoo Aniel Q, Wolfe Thomas, Patel Neil V, Roark Christopher, Siddiqui Adnan H, Grandhi Ramesh, EMBOLISE Investigators
Аннотация
MATERIALS AND METHODS: A cost-effectiveness analysis using 2024 US dollars was conducted averaging hospital costing data from 2 EMBOLISE trial sites for 42 patients with cSDH (21 ES/MMAE, 21 ES alone) from a US hospital (health facility) perspective, with clinical data (eg, cSDH recurrence rates) derived from the EMBOLISE trial. Quality-adjusted life years (QALYs) were derived from EuroQol 5-dimension 5-level assessment data with a 180-day horizon. Incremental cost-effectiveness ratio (ICER) was calculated. One- and 2-way sensitivity analyses and probabilistic sensitivity analysis (PSA) with 5000 Monte Carlo iterations (gamma distributions for costs and beta for utilities/probabilities) were performed.
RESULTS: Mean expected costs were $23,809 for ES/MMAE (4.1% recurrence rate), $17,197 for ES alone (11.3% recurrence rate), and $10,376 for rescue surgery for either treatment. ES/MMAE provided a 0.02 QALY gain over ES alone, at an incremental cost of $6612. The resultant ICER was approximately $382,267.50/QALY, exceeding the commonly cited $100,000/QALY cost-effectiveness criterion. One-way sensitivity analyses indicated QALY gain was the most impactful economic driver. PSA indicated a 31.8% probability of ES/MMAE being cost-effective at $100,000/QALY (68.2% for ES alone).
CONCLUSIONS: At 2024 pricing, and from a US hospital perspective, ES/MMAE for cSDH may not be cost-effective within a 180-day horizon, but PSA suggests a greater favorability toward ES/MMAE at higher willingness-to-pay thresholds. The positive net QALY benefit with adjunctive MMAE for cSDH suggests a small but meaningful quality-of-life improvement, preventing complete ES dominance. Cost-reduction strategies, longer time frames, and validated cSDH-specific patient-reported outcome measures could enhance ES/MMAE cost-effectiveness. These findings could guide future optimization efforts for ES/MMAE for cSDH management.