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 journalArticle

21 Citations (Scopus)

Abstract

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
JournalStroke
Volume40
Issue number6
Early online date6 Apr 2009
DOIs
Publication statusPublished - Jun 2009

Keywords

  • 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

Cite this

Economic burden of intracranial vascular malformations in adults : prospective population-based study. / Miller, Clare E; Quayyum, Zahidul; McNamee, Paul; Al-Shahi Salman, Rustam; SIVMS Steering Committee ; Counsell, Carl Edward.

In: Stroke, Vol. 40, No. 6, 06.2009, p. 1973-1979.

Research output: Contribution to journalArticle

Miller, Clare E ; Quayyum, Zahidul ; McNamee, Paul ; Al-Shahi Salman, Rustam ; SIVMS Steering Committee ; Counsell, Carl Edward. / Economic burden of intracranial vascular malformations in adults : prospective population-based study. In: Stroke. 2009 ; Vol. 40, No. 6. pp. 1973-1979.
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abstract = "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.)",
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T1 - Economic burden of intracranial vascular malformations in adults

T2 - prospective population-based study

AU - Miller, Clare E

AU - Quayyum, Zahidul

AU - McNamee, Paul

AU - Al-Shahi Salman, Rustam

AU - SIVMS Steering Committee

AU - Counsell, Carl Edward

PY - 2009/6

Y1 - 2009/6

N2 - 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.)

AB - 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.)

KW - Age Factors

KW - Aged

KW - Ambulatory Care

KW - Cavernous Sinus

KW - Cerebral Angiography

KW - Cerebral Hemorrhage

KW - Cohort Studies

KW - Efficiency

KW - Female

KW - Health Care Costs

KW - Hospitalization

KW - Humans

KW - Intracranial Arteriovenous Malformations

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Neurosurgical Procedures

KW - Population

KW - Prospective Studies

KW - Scotland

KW - Tomography, X-Ray Computed

U2 - 10.1161/STROKEAHA.108.539528

DO - 10.1161/STROKEAHA.108.539528

M3 - Article

C2 - 19359648

VL - 40

SP - 1973

EP - 1979

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 6

ER -