C. E. Miller, Z. Quayyum, P. McNamee, R. A. S. Salman, Sivms Steering Comm



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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.)