Department of Neurosurgery, Kanto Rosai Hospital, Kanagawa, Japan.
Department of Neurosurgery, Kanto Rosai Hospital, Kanagawa, Japan.
World Neurosurg. 2024 Oct;190:e175-e180. doi: 10.1016/j.wneu.2024.07.086. Epub 2024 Jul 19.
Despite numerous articles about middle meningeal artery embolization (MMAE) highlighting its efficacy and safety for recurrent chronic subdural hematoma (CSDH), the appropriateness of adjunctive MMAE after hematoma evacuation for initial CSDH remains unclear from a cost-effectiveness perspective.
Patients with CSDH were enrolled in this study and were prospectively divided into 2 groups: the "conventional treatment" group, which was treated with hematoma evacuation alone, and the "MMAE" group, which was treated with adjunctive MMAE after hematoma evacuation. The proportion of patients requiring retreatment, length of hospital stay, economic costs, and modified Rankin Score were compared between the 2 groups.
In this study, 53 cases were included, with 30 classified into the conventional treatment group and 23 classified into the MMAE group. In the conventional treatment group, the proportion of patients who required surgical retreatment was higher than that in the MMAE group (16.7% vs. 8.7%). The relative risk was 0.522 (95% confidence interval, 0.111-2.45). Although the addition of MMAE increased the cost per hospitalization by 26%, the increase in cost per patient was limited to 12%, owing to the reduction in patients who relapsed and required a second hospitalization. The increase in cost was not statistically significant. The MMAE group had a significantly higher proportion of patients with favorable outcomes (modified Rankin Score 0-2) (56.7% vs. 87.0%, P = 0.0328).
By minimizing the increase in hospitalization days and procedure costs, MMAE following hematoma evacuation for initial CSDH could decrease the retreatment rate and balance the total medical costs associated with MMAE.
尽管有许多关于脑膜中动脉栓塞（MMAE）的文章强调了其在复发性慢性硬膜下血肿（CSDH）中的疗效和安全性，但从成本效益的角度来看，在血肿清除术后辅助 MMAE 治疗初始 CSDH 的适宜性尚不清楚。
本研究纳入了 CSDH 患者，并前瞻性地将其分为 2 组：“常规治疗”组，仅接受血肿清除术治疗；“MMAE”组，在血肿清除术后接受辅助 MMAE 治疗。比较两组患者的再治疗比例、住院时间、经济成本和改良 Rankin 评分。
本研究共纳入 53 例患者，其中 30 例归入常规治疗组，23 例归入 MMAE 组。在常规治疗组中，需要手术再治疗的患者比例高于 MMAE 组（16.7% vs. 8.7%）。相对风险为 0.522（95%置信区间，0.111-2.45）。尽管辅助 MMAE 使每次住院的成本增加了 26%，但由于减少了复发并需要第二次住院的患者数量，每位患者的成本增加限制在 12%以内。增加的成本没有统计学意义。MMAE 组有更多的患者（改良 Rankin 评分 0-2）结局良好（56.7% vs. 87.0%，P=0.0328）。
通过最大限度地减少住院天数和手术成本的增加，在初始 CSDH 血肿清除术后进行 MMAE 可以降低再治疗率，并平衡与 MMAE 相关的总医疗成本。
