A Review of Preoperative Embolization Effectiveness in Patients With Arteriovenous Malformations
Copyright © Congress of Neurological Surgeons 2023. All rights reserved..
BACKGROUND AND OBJECTIVES: Preoperative embolization of arteriovenous malformations (AVMs) remains controversial. This study sought to analyze the cost-effectiveness of preoperative embolization of AVMs.
METHODS: Patients who underwent AVM resection at a single institute (January 1, 2015-December 31, 2020) were analyzed. Patients with preoperative embolization (embolization cohort) were compared with those without preoperative embolization (nonembolization cohort). Cost-effectiveness score (CE) was the primary outcome of interest and was determined by dividing the total 1-year cost by effectiveness, which was derived from a validated preoperative to last follow-up change in the modified Rankin Scale utility score. A lower CE signifies a more cost-effective treatment strategy.
RESULTS: Of 188 patients, 88 (47%) underwent preoperative embolization. The mean (SD) total cost was higher in the embolization group than in the nonembolization group ($117 594 [$102 295] vs $84 348 [$82 326]; P < .001). The mean (SD) CE was higher in the embolization cohort ($336 476 [$1 303 842]) than in the nonembolization cohort ($100 237 [$246 255]; P < .001). Among patients with Spetzler-Martin (SM) grade I and II AVMs, the mean (SD) CE was higher in the embolization (n = 40) than in the nonembolization (n = 72) cohort ($164 950 [$348 286] vs $69 021 [$114 938]; P = .004). Among patients with SM grade III AVMs, the mean (SD) CE was lower in the embolization (n = 33) than in the nonembolization (n = 25) cohort ($151 577 [$219 130] vs $189 195 [$446 335]; P = .006). The mean (SD) CE was not significantly different between cohorts among patients with higher-grade AVMs (embolization cohort [n = 3] vs nonembolization cohort [n = 15]: $503 639 [$776 492] vs $2 048 419 [$4 794 758]; P = .49). The mean CE for embolized SM grade III aneurysms was nonsignificant in the ruptured group; however, for the unruptured group, CE was significantly higher in the embolization cohort (n = 26; $160 871 [$240 535]) relative to the nonembolization cohort (n = 15; $108 152 [$166 446]) ( P = .006).
CONCLUSION: Preoperative embolization was cost-effective for patients with SM grade III AVMs but not for patients with lower-grade AVMs.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:94 |
|---|---|
| Enthalten in: |
Neurosurgery - 94(2024), 1 vom: 01. Jan., Seite 129-139 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Catapano, Joshua S [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 16.12.2023 Date Revised 01.02.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1227/neu.0000000000002629 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM360225837 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM360225837 | ||
| 003 | DE-627 | ||
| 005 | 20240202231958.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1227/neu.0000000000002629 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1278.xml |
| 035 | |a (DE-627)NLM360225837 | ||
| 035 | |a (NLM)37522732 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Catapano, Joshua S |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A Review of Preoperative Embolization Effectiveness in Patients With Arteriovenous Malformations |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 16.12.2023 | ||
| 500 | |a Date Revised 01.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © Congress of Neurological Surgeons 2023. All rights reserved. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: Preoperative embolization of arteriovenous malformations (AVMs) remains controversial. This study sought to analyze the cost-effectiveness of preoperative embolization of AVMs | ||
| 520 | |a METHODS: Patients who underwent AVM resection at a single institute (January 1, 2015-December 31, 2020) were analyzed. Patients with preoperative embolization (embolization cohort) were compared with those without preoperative embolization (nonembolization cohort). Cost-effectiveness score (CE) was the primary outcome of interest and was determined by dividing the total 1-year cost by effectiveness, which was derived from a validated preoperative to last follow-up change in the modified Rankin Scale utility score. A lower CE signifies a more cost-effective treatment strategy | ||
| 520 | |a RESULTS: Of 188 patients, 88 (47%) underwent preoperative embolization. The mean (SD) total cost was higher in the embolization group than in the nonembolization group ($117 594 [$102 295] vs $84 348 [$82 326]; P < .001). The mean (SD) CE was higher in the embolization cohort ($336 476 [$1 303 842]) than in the nonembolization cohort ($100 237 [$246 255]; P < .001). Among patients with Spetzler-Martin (SM) grade I and II AVMs, the mean (SD) CE was higher in the embolization (n = 40) than in the nonembolization (n = 72) cohort ($164 950 [$348 286] vs $69 021 [$114 938]; P = .004). Among patients with SM grade III AVMs, the mean (SD) CE was lower in the embolization (n = 33) than in the nonembolization (n = 25) cohort ($151 577 [$219 130] vs $189 195 [$446 335]; P = .006). The mean (SD) CE was not significantly different between cohorts among patients with higher-grade AVMs (embolization cohort [n = 3] vs nonembolization cohort [n = 15]: $503 639 [$776 492] vs $2 048 419 [$4 794 758]; P = .49). The mean CE for embolized SM grade III aneurysms was nonsignificant in the ruptured group; however, for the unruptured group, CE was significantly higher in the embolization cohort (n = 26; $160 871 [$240 535]) relative to the nonembolization cohort (n = 15; $108 152 [$166 446]) ( P = .006) | ||
| 520 | |a CONCLUSION: Preoperative embolization was cost-effective for patients with SM grade III AVMs but not for patients with lower-grade AVMs | ||
| 650 | 4 | |a Review | |
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Koester, Stefan W |e verfasserin |4 aut | |
| 700 | 1 | |a Rumalla, Kavelin |e verfasserin |4 aut | |
| 700 | 1 | |a Rangel, India C |e verfasserin |4 aut | |
| 700 | 1 | |a Stonnington, Henry O |e verfasserin |4 aut | |
| 700 | 1 | |a Singh, Rohin |e verfasserin |4 aut | |
| 700 | 1 | |a Memon, Ali |e verfasserin |4 aut | |
| 700 | 1 | |a Kimata, Anna R |e verfasserin |4 aut | |
| 700 | 1 | |a Winkler, Ethan A |e verfasserin |4 aut | |
| 700 | 1 | |a Baranoski, Jacob F |e verfasserin |4 aut | |
| 700 | 1 | |a Cole, Tyler S |e verfasserin |4 aut | |
| 700 | 1 | |a Graffeo, Christopher S |e verfasserin |4 aut | |
| 700 | 1 | |a Srinivasan, Visish M |e verfasserin |4 aut | |
| 700 | 1 | |a Jadhav, Ashutosh P |e verfasserin |4 aut | |
| 700 | 1 | |a Ducruet, Andrew F |e verfasserin |4 aut | |
| 700 | 1 | |a Albuquerque, Felipe C |e verfasserin |4 aut | |
| 700 | 1 | |a Lawton, Michael T |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Neurosurgery |d 1993 |g 94(2024), 1 vom: 01. Jan., Seite 129-139 |w (DE-627)NLM000294977 |x 1524-4040 |7 nnns |
| 773 | 1 | 8 | |g volume:94 |g year:2024 |g number:1 |g day:01 |g month:01 |g pages:129-139 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1227/neu.0000000000002629 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 94 |j 2024 |e 1 |b 01 |c 01 |h 129-139 | ||