Supply cost and outcome comparison of nBCA, Onyx, and coils for middle meningeal artery embolizations: a single-center retrospective analysis.

Abstract

Background: Middle meningeal artery (MMA) embolization is increasingly utilized in the treatment of chronic subdural hematoma (cSDH); however, supply cost variation between embolization agents remains unclear. We hypothesized that nBCA might be associated with lower costs, given the ability to use a single vial and treat multiple pedicles.

Objective: To compare the supply costs of MMA embolizations using ethylene vinyl-alcohol copolymer-based Onyx (Onyx), n-butyl cyanoacrylate-based TRUFILL (nBCA), and/or coils.

Methods: This retrospective study analyzed 100 consecutive MMA embolizations performed at a single institution before March 2025. The supplies (including catheters and embolic agents) used in each embolization, along with procedure time, laterality, and number of pedicles embolized, were documented. Radiographic and clinical patient outcomes were evaluated.

Results: Of the 100 procedures: 63 used nBCA, 26 Onyx, 2 coils, 2 nBCA and coils, and 7 Onyx and coils. Supply costs ranged from approximately $5000 to $18 000. Onyx was significantly less expensive than nBCA in supply cost per patient ($7910 vs $10 241; P<0.0001), cost per side ($6467 vs $7857; P=0.010), and cost per pedicle ($4375 vs $5369; P=0.012). Mean cost per patient was highest for nBCA and coils ($13 541 ± $1331), Onyx and coils ($12 364 ± $3259), and coils alone ($11 058 ± $1144). There were no significant differences in short-term complications (stroke, seizure, cranial nerve palsy, retreatment, hospital readmissions; P>0.05), functional outcomes (modified Rankin Scale; P=0.813), or complete cSDH resolution (P=0.149) between embolic techniques.

Conclusions: There is significant variation in supply cost associated with different MMA embolization techniques. In our institutional experience, Onyx was associated with the lowest supply cost per patient, hemisphere, and pedicle. Complication rates and functional status did not significantly differ across techniques.