Cost determinants come to light for managing blood-vessel abnormalities in the brain

Arteriovenous malformations (AVMs) in the brain are best obliterated with surgery following preoperative embolization. However, radiosurgery is a considerably less costly option that may suffice in some cases.

So suggest findings from researchers at UC-San Francisco who looked at cost determinants in the management of brain AVMs and had their study published online Nov. 23 in the European Journal of Neurosurgery.

While rare, brain AVMS—tangles of abnormal blood vessels—can be present with no symptoms until a rupture occurs, in which case a resulting brain bleed can be life-threatening.

Neurosurgeon Caleb Rutledge, MD, radiologist Daniel Cooke, MD, and colleagues analyzed data on 140 patients who were treated for brain AVMs at their institution over a four-year period.

UCSF maintains a brain AVM registry, and from this the team gathered information on treatment type, length of stay, radiographic evidence of AVM removal and other factors.

Reviewing postprocedure imaging exams for AVM obliteration between treatment modalities, they found surgery with preoperative embolization to be the best but costliest treatment: a median of $91,948 with a range of $79,914 to $140,600.

By comparison, the radiosurgery had a median price tag of $20,917 with a range of $13,915 to $35,583.

“Hemorrhage, AVM grade and treatment modality are significant cost determinants in AVM management,” the authors conclude. “Surgery with preoperative embolization was the costliest treatment and radiosurgery the least; however, surgical cases had significantly higher rates of obliteration.”