ArticleCureus2026
Early Cost Analysis of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Treatment: A National Claims Database Analysis (MarketScan, 2007-2023).
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMiddle meningeal artery (MMA) embolization has emerged as a promising, minimally invasive treatment for chronic subdural hematoma (cSDH), with randomized controlled trials demonstrating reduced recurrence compared with surgery alone. However, real-world data comparing standalone MMA embolization, surgical evacuation alone (burr hole drainage or craniotomy), and combined MMA embolization with surgical evacuation remain limited, particularly regarding comparative safety, short-term outcomes, and healthcare costs.
methodsWe conducted a retrospective analysis of MarketScan Commercial Claims and Encounters (2007-2023) identifying patients with nontraumatic SDH undergoing burr hole evacuation, craniotomy, or MMA embolization. Demographics, comorbidities, in-hospital and 30- and 90-day outcomes, costs, and reinterventions were compared across cohorts.
resultsA total of 16,291 patients were identified (7,147 burr holes, 8,757 craniotomies, 387 MMA embolizations). MMA embolization increased from 2% of cases in 2018 to 30% by 2023. MMA embolization patients had more comorbidities, including double the rate of coagulopathy (22% vs. 11-12%; p < 0.001). While index hospitalization cost for MMA embolization was the highest (median $69,383), driven by multistep interventional billing, 90-day postoperative cost was intermediate ($10,343) compared to craniotomy ($12,714) and burr hole ($6,877; p < 0.001). In-hospital mortality was lowest for MMA embolization (2%) versus burr holes (3%) and craniotomy (11%; p < 0.001). Patients undergoing combined MMA embolization and open surgery had substantially higher 90-day costs ($24,496) and stroke/transient ischemic attack (TIA) rates (40%).
conclusionsMMA embolization has been rapidly adopted for cSDH treatment, offering favorable short-term outcomes and an intermediate cost profile to higher-risk patients. Poor outcomes with combined surgical and embolization procedures warrant further investigation. These findings support MMA embolization as practice-changing technology while highlighting the need for long-term prospective studies to optimize patient selection and cost-effectiveness.
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