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

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