Economic analysis of n-butyl cyanoacrylate compared with ethylene vinyl alcohol copolymer liquid embolic embolization of brain arteriovenous malformations (bAVMs) from a US hospital perspective

Abstract

Background In US hospitals, the liquid embolic systems (LESs) n-butyl cyanoacrylate (n-BCA) and ethylene vinyl alcohol copolymer (EVOH) are used for brain arteriovenous malformation (bAVM) embolization to achieve presurgical devascularization. The aim of this study was to perform an economic analysis comparing four techniques for bAVM embolization based on LES, ancillary device, and angiography suite time costs. Methods An economic model was developed comparing the embolization costs for n-BCA, EVOH with the plug and push technique, EVOH with detachable-tip microcatheters, and EVOH with balloon microcatheters. Per procedure costs were calculated for bAVMs with one to four pedicles. Annual cohort analyses were performed to evaluate the potential impact for low and high-volume centers. Sensitivity analyses were performed to determine cost drivers. Results The analyses showed that the n-BCA technique was the least costly of the four techniques. Total per procedure costs for one to four embolized pedicles ranged from $5941 to $10,074 for the n-BCA technique, $8428 to $30,345 for the EVOH balloon microcatheter technique, $12,711 to $47,477 for the EVOH plug and push technique, and $13,900 to $52,233 for the EVOH detachable-tip microcatheter technique. Cohort analyses costs for 52 annual cases ranged from $308,953 to $523,838 with the n-BCA technique and from $722,816 to $2,716,096 with the EVOH detachable-tip microcatheter technique. Conclusions Procedure costs associated with n-BCA are lower than those with each of the three EVOH techniques examined. Future cost analyses should compare the costs of new LES products once available.

Comparative cost analysis of liquid embolization systems for brain arteriovenous malformation using a real-world US hospital database: TRUFILL® versus OnyxTM

“…A recently published economic model, leveraging a clinician-verified clinical scenario, compared costs associated with the required LES units and ancillary devices, as well as the procedural time differences between TRUFILL using a 3:1 dilution and three techniques using Onyx. 7 The study concluded that the use of TRUFILL resulted in the use of fewer devices and shorter procedure time compared to any of the Onyx techniques examined. Higher costs were driven by additional units of Onyx as well as additional or specialty microcatheters needed for deployment.…”

“…Higher costs were driven by additional units of Onyx as well as additional or specialty microcatheters needed for deployment. 7 Clinical outcomes including safety, efficacy, and effectiveness in studies comparing TRUFILL and Onyx in treating patients with bAVMs have been widely assessed in the literature, and collectively show similar outcomes regarding safety and bAVM obliteration. 5,6,12,13 Interestingly, studies providing direct comparisons of the costs associated with TRUFILL and Onyx in treating patients with bAVM are scarce, and costs must be inferred from procedural characteristics and resource utilization.…”

“…One recent study demonstrated lower device costs associated with patients treated with TRUFILL compared to three techniques using Onyx, based on an economic model. 7 The objective of this study was to assess total procedure costs, supply costs, and hospital length of stay (LOS) among unruptured bAVM patients undergoing embolization procedures using TRUFILL compared to Onyx LES in the United States (US) using real-world data.…”