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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.
Catapano et al. (Mon,) studied this question.