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(Stroke. 2009;40:1973.)
© 2009 American Heart Association, Inc.

Original Contributions

Economic Burden of Intracranial Vascular Malformations in Adults

Prospective Population-Based Study

Clare E. Miller, BSc, MBChB; Zahidul Quayyum, MA, MSc; Paul McNamee, MA, PhD; Rustam Al-Shahi Salman, MA, PhD, FRCP Edin on behalf of the SIVMS Steering Committee

From the Division of Clinical Neurosciences (C.E.M., R.A.-S.S.), University of Edinburgh; and the Health Economics Research Unit (P.M., Z.Q.), University of Aberdeen, UK.

Correspondence to Dr Rustam Al-Shahi Salman, MRC Clinician Scientist, Bramwell Dott Building, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK. E-mail Rustam.Al-Shahi{at}ed.ac.uk

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 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 (£15 784 versus £1385, 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 £17 111 for AVMs and £6752 for CMs (P=0.1), and the projected 3-year cost of lost productivity for all 369 adults was £8.7 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.

Key Words: intracranial arteriovenous malformations • central nervous system vascular malformations • economics • cost of illness