Middle meningeal artery embolisation reduces chronic subdural haematoma recurrence: A meta-analysis of EMBOLISE, STEM, MAGIC-MT and EMPROTECT trials and cost analysis

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-08-28 DOI:10.1016/j.clineuro.2025.109128

Nithish Jayakumar , Oliver Kennion , Ian Coulter

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Abstract

Objective

To assess the effectiveness and cost implications of middle meningeal artery embolisation (MMAE) in reducing recurrence of chronic subdural haematoma (CSDH) requiring surgery, through a meta-analysis of the four largest randomized controlled trials (RCTs) published to date.

Methods

A systematic review and meta-analysis were conducted on four RCTs (EMBOLISE, STEM, MAGIC-MT, EMPROTECT) comparing MMAE to standard treatment in adult patients with CSDH. The primary outcome was recurrence requiring surgery. Secondary outcomes included modified Rankin Scale (mRS) at follow-up, mortality, adverse events, and hospital stay. A United Kingdom-based cost analysis was performed using National Health Service (NHS) payment tariffs and institutional estimates to evaluate economic viability.

Results

MMAE significantly reduced recurrence requiring surgery (pooled risk ratio [RR]=0.40, 95 % CI: 0.28–0.58; p < 0.00001). No significant differences were found in mortality (RR 0.94, p = 0.85), serious adverse events (RR 0.92, p = 0.47), or functional independence at follow-up (OR 0.97, p = 0.88). The estimated number needed to treat was 15. Cost analysis showed that while MMAE could prevent 53 surgical recurrences in a historical cohort of CSDH patients from the United Kingdom, it could incur a net loss of £ 1.6–1.9 million under current NHS tariffs.

Conclusion

MMAE is effective and safe in reducing CSDH recurrence but is not currently cost-effective for universal use in the NHS. Selective use in high-risk patients and cost-reduction strategies may enhance its economic viability.

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脑膜中动脉栓塞减少慢性硬膜下血肿复发：栓塞、STEM、MAGIC-MT和EMPROTECT试验的荟萃分析和成本分析

目的通过对迄今为止发表的四项最大的随机对照试验（RCTs）的荟萃分析，评估脑膜中动脉栓塞（MMAE）在减少需要手术的慢性硬膜下血肿（CSDH）复发方面的有效性和成本影响。方法对4项随机对照试验（EMBOLISE、STEM、MAGIC-MT、EMPROTECT）进行系统评价和荟萃分析，比较MMAE与成人CSDH患者的标准治疗。主要预后是需要手术治疗的复发。次要结局包括随访时的修正兰金量表（mRS）、死亡率、不良事件和住院时间。基于英国的成本分析使用国民保健服务（NHS）支付关税和机构估计来评估经济可行性。结果smmae显著降低手术复发率（合并风险比[RR]=0.40, 95 % CI: 0.28-0.58; p <； 0.00001）。在死亡率（RR 0.94, p = 0.85）、严重不良事件（RR 0.92, p = 0.47）和随访时功能独立性（or 0.97, p = 0.88）方面均无显著差异。估计需要治疗的人数为15人。成本分析显示，虽然MMAE可以防止来自英国的CSDH患者的历史队列中的53例手术复发，但在当前的NHS关税下，它可能导致净损失 160 - 190万英镑。结论mmae在降低CSDH复发率方面是安全有效的，但目前在NHS普遍使用的成本效益不高。高风险患者的选择性使用和降低成本的策略可能会提高其经济可行性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.