Analysis of Treatment Cost Variation Among Multiple Neurosurgical Procedures Using the Value-Driven Outcomes Database.

Abstract

BACKGROUND:

Health care costs comprise a substantial portion of total national expenditure. Although interest in cost-effectiveness analysis in neurosurgery has increased, there has been little cross-comparison of neurosurgical procedures. The aim of this study was to compare costs across elective neurosurgical procedures to understand whether drivers of cost differ.

METHODS:

The Value Driven Outcomes database was used to evaluate treatment costs for resection of vestibular schwannoma, intracranial meningioma, gliomas, and pituitary adenoma; anterior cervical discectomy and fusion and lumbar spinal fusion; and aneurysm treatment.

RESULTS:

A total of 1997 patients (mean age 54.6 ± 14.5 years; 45.2% male) were evaluated. The mean length of stay (LOS) was 4.0 ± 4.4 days. For cases involving hardware implantation, including spine fusion or aneurysm treatment, supplies and implants (49.1%) accounted for the largest fraction of costs followed by facility costs (37.9%). For cases that did not involve hardware, including tumor cases, facility costs (63.9%) were the largest fraction, followed by supplies and implants (16.2%). Aneurysm treatment and lumbar fusion were 1.5-3 times more costly than cranial tumor resection and anterior cervical discectomy and fusion per patient. Multivariate linear regression demonstrated that LOS (β = 0.7, P = 0.0001) and patient treatment type (β = 0.2, P = 0.0001) had the greatest effect on costs. LOS correlated with cost differently depending on case type; its effect was largest for patients with meningioma and smallest for patients with vestibular schwannoma. Costs across time increased similarly for all case types.

CONCLUSIONS:

Costs for neurosurgical procedures vary widely depending on treatment type and correlated directly with LOS. Strategies to reduce cost may require different approaches depending on procedure type.

• Authors: Jared C Reese, Spencer Twitchell, Herschel Wilde, Mohammed A Azab, Jian Guan, Michael Karsy, William T Couldwell
• Journal: World neurosurgery (World Neurosurg) Vol. 126 Pg. e914-e920 (Jun 2019) ISSN: 1878-8769 [Electronic] United States
• PMID: 30872202 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Brain Neoplasms (surgery)
• Cost-Benefit Analysis
• Databases, Factual
• Diskectomy (economics)
• Female
• Health Care Costs
• Humans
• Length of Stay (economics)
• Male
• Middle Aged
• Neuroma, Acoustic (surgery)
• Neurosurgical Procedures (economics)
• Spinal Diseases (surgery)
• Spinal Fusion (economics)