Cost determinants in management of brain arteriovenous malformations

  • Caleb RutledgeEmail author
  • Jeffrey Nelson
  • Alex Lu
  • Peyton Nisson
  • Soren Jonzzon
  • Ethan A Winkler
  • Daniel Cooke
  • Adib A Abla
  • Michael T. Lawton
  • Helen Kim
Original Article - Vascular Neurosurgery - Arteriovenous malformation
Part of the following topical collections:
  1. Vascular Neurosurgery – Arteriovenous malformation



There is little data on the cost of treating brain arteriovenous malformations (AVMs). The goal of this study then is to identify cost determinants in multimodal management of brain AVMs.


One hundred forty patients with brain AVMs prospectively enrolled in the UCSF brain AVM registry and treated between 2012 and 2015 were included in the study. Patient and AVM characteristics, treatment type, and length of stay and radiographic evidence of obliteration were collected from the registry. We then calculated the cost of all inpatient and outpatient encounters, interventions, and imaging attributable to the AVM. We used generalized linear models to test whether there was an association between patient and AVM characteristics, treatment type, and cost and length of stay. We tested whether the proportion of patients with radiographic evidence of obliteration differed between treatment modalities using Fisher’s exact test.


The overall median cost of treatment and interquartile range was $77,865 (49,566–107,448). Surgery with preoperative embolization was the costliest treatment at $91,948 (79,914–140,600), while radiosurgery was the least at $20,917 (13,915–35,583). In multi-predictor analyses, hemorrhage, Spetzler-Martin grade, and treatment type were significant predictors of cost. Patients who had surgery had significantly higher rates of obliteration compared with radiosurgery patients.


Hemorrhage, AVM grade, and treatment modality are significant cost determinants in AVM management. Surgery with preoperative embolization was the costliest treatment and radiosurgery the least; however, surgical cases had significantly higher rates of obliteration.


Brain arteriovenous malformation Cost Cost-effectiveness 


Compliance with ethical standards

The study was approved by the University of California San Francisco Committee on Human Research and conducted in compliance with Health Insurance Portability and Accountability Act regulations.

Conflict of interest

The authors declare that they have no conflict of interest.

For this retrospective study, formal consent is not required


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Center for Cerebrovascular Research, Department of Anesthesia and Perioperative CareUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of Neurological SurgeryBarrow Neurological InstitutePhoenixUSA
  4. 4.Department of Radiology and Biomedical ImagingUniversity of California, San FranciscoSan FranciscoUSA

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