Economic burden of intracranial vascular malformations in adults: prospective population-based study

Clare E Miller, Zahidul Quayyum, Paul McNamee, Rustam Al-Shahi Salman, SIVMS Steering Committee, Carl Edward Counsell

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)


Background and Purpose-Although intracranial vascular malformations (IVMs) are the leading cause of intracerebral hemorrhage (ICH) in young adults, there has not been a cost-of-illness study on an unselected cohort.

Methods-We measured the direct healthcare costs (inpatient, outpatient, intervention, and brain imaging) incurred by every adult within 3 years after their first presentation with a brain arteriovenous malformation (AVM) or cavernous malformation (CM) in a prospective, population-based study. We estimated the indirect cost of lost productivity for the whole cohort over the same period by projecting questionnaire responses from living consenting adults.

Results-369 adults (AVM = 229 [62%], CM = 140 [38%]) incurred healthcare costs of 5.96 pound million over 3 years, of which AVMs accounted for 90%, inpatient care accounted for 75%, and the first year of care accounted for 69%. Median 3-year healthcare costs were statistically significantly higher for adults presenting with ICH, aged <65 years, receiving interventional treatment, and adults with AVMs rather than CMs (15 pound 784 versus 1385 pound, P < 0.0005). Healthcare costs diminished with increasing AVM nidus size (P = 0.005). Mean 3-year costs of lost productivity per questionnaire respondent (n = 145) were 17 pound 111 for AVMs and 6752 pound for CMs (P = 0.1), and the projected 3-year cost of lost productivity for all 369 adults was 8.7 pound million.

Conclusions-The costs of healthcare and lost productivity attributable to IVMs are considerable, and highest in those aged <65 years, presenting with ICH, receiving interventional treatment, and harboring AVMs rather than CMs. Long-term studies of the cost-effectiveness of interventional treatment are needed. (Stroke. 2009; 40: 1973-1979.)

Original languageEnglish
Pages (from-to)1973-1979
Number of pages7
Issue number6
Early online date6 Apr 2009
Publication statusPublished - Jun 2009


  • Age Factors
  • Aged
  • Ambulatory Care
  • Cavernous Sinus
  • Cerebral Angiography
  • Cerebral Hemorrhage
  • Cohort Studies
  • Efficiency
  • Female
  • Health Care Costs
  • Hospitalization
  • Humans
  • Intracranial Arteriovenous Malformations
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neurosurgical Procedures
  • Population
  • Prospective Studies
  • Scotland
  • Tomography, X-Ray Computed


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