Introduction In the evolving landscape of chronic subdural hematoma (cSDH) treatment, Middle Meningeal Artery Embolization (MMAE) emerges as an adjunct and alternative to conventional surgical drainage (CSD). Three randomized clinical trials demonstrated benefit in terms of reduced recurrence of cSDH and re-operation rates after MMAE. In parallel, examination of how MMAE influences the economics of cSDH management is needed.

Methods The data used is MarketScan from Merative. Patients undergoing treatment for cSDH were divided into three groups: 1) conventional surgical drainage (CSD), including burr-hole or craniotomy or craniectomy, 2) CSD plus adjunctive MMAE, and 3) MMAE alone. Inclusion/exclusion criteria are defined based on corresponding ICD-10 and CPT codes. Patients older than 18 years with new diagnosis of cSDH who are treated within 3-months are included.

Results From 2017–2022, there were 2108 treated cSDH patients, who underwent CSD (n=2015), or CSD+MMAE (n=23) or MMAE only (n=70). Median age of the surgical group was 61 years (IQR 53–73 yrs), the surgery plus MMAE was 67 yrs (56–77 yrs) and the MMAE group was 65 years (55–77 yrs). There were no statistically significant differences in Elixhauser Comorbidity Scores between the groups (p>0.05). Median hospital days were significantly longer for the CSD (6 (IQR 5–7) days) and CSD + MMAE (7 (IQR 6–7) days) groups compared to MMAE only (0 days(IQR 0–1)(p<0.0001). Median index hospitalization payments were significantly higher for the CSD+MMAE group ($74,568) compared to both CSD ($39,658) (p<0.003) and MMAE groups ($22,286) (p<0.001). 0% of the conventional surgical drainage group, 4% of the surgical + MMAE group, and 5% of the MMAE group required reoperation over a 6-month follow-up period, which did not reach statistical significance. There were no significant differences in other medical complications, ER visits rates or hospitalization rates. The total median payments at 6-month follow-up for the CSD group were higher compared to CSD+MMAE ($11494 vs $7300, p=0.0017) but not compared to MMAE only ($10,680, p=0.08) (table 1).

Conclusion Stand-alone MMAE is associated with shorter hospital length of stay and lower median index hospital payments compared to CSD and CSD+MMAE, which may economically favor MMAE for cSDHs as a first-line option in the appropriate candidates. CSD+MMAE incurred higher median index hospital payments compared to both CSD and MMAE only groups, likely attributable to combined procedure costs. However, at 6-month follow up, CSD had higher median payments compared to CSD+MMAE. Larger longer-term follow-up is required to analyze outcomes which may underly healthcare costs.

Disclosures K. John: None. N. Dietz: None. A. Brake: None. B. Ugiliweneza: None. D. Drazin: None. I. Abecassis: None. D. Ding: None. M. Boakye: None.