Socioeconomic Costs of Open Surgery and Gamma Knife Radiosurgery for Benign Cranial Base Tumors

OBJECTIVE:The aim of this study was to evaluate the relative socioeconomic costs of benign cranial base tumors treated with open surgery and gamma knife radiosurgery. METHODS:In a retrospective study, we studied 174 patients with benign cranial base tumors, less than 3 cm in diameter (or volume less than 30 ml), admitted in the past 5 years. Group A (n = 94) underwent open surgery for removal of the tumors, whereas Group B (n = 80) underwent gamma knife radiosurgery. The socioeconomic costs were evaluated by both direct and indirect cost. The direct costs comprised intensive care unit cost, ward cost, operating room cost, and outpatient visiting cost. The indirect costs included loss of workdays and mortality. The length of hospital stay, the number of lost workdays, surgical complications, mortality, and cost-effectiveness analysis were calculated as well. Student t test and &khgr;2 test were used for statistical analysis. RESULTS:The mean length of hospital stay for open surgery was 18.2 ± 30.4 days including 5.0 ± 14.7 days of intensive care unit stay and 13.0 ± 15.2 days of ward stay, P < 0.01. The mean hospital stay for gamma knife was 2.2 ± 0.9 days with no need of intensive care unit stay, P < 0.01. The mean loss of workdays for open surgery was 160 ± 158 days and 8.0 ± 9.0 days for gamma knife, P < 0.01. The gamma knife cost per hour (US $1435) is higher than the open surgery cost per hour (US $450), P < 0.01. The direct cost for gamma knife (US $9677 ± $6700) is higher than that for open surgery (US $5837 ± $6587), P < 0.01. Open surgery had more complication rates (31.2%) than gamma knife (3.8%). Open surgery had a mortality rate of 5.3%; there was no mortality for gamma knife. The indirect costs, including loss of workdays and mortality, were significantly higher for open surgery than for gamma knife, P < 0.01. Finally, the socioeconomic cost (US $34,453 ± $97,277) is higher for open surgery than for gamma knife (US $10,044 ± $7481), P < 0.01. The CEA is significantly higher in gamma knife (US $3762/quality-adjusted life year) than in open surgery (US $8996/quality-adjusted life year), P < 0.01. CONCLUSION:Most of the socioeconomic loss with open surgery for benign cranial base tumors comes from the indirect costs of workdays lost and mortality. Gamma knife radiosurgery is a worthwhile treatment to our patients and to our society because it may shorten hospital stays and workdays lost and reduce complications, mortality, socioeconomic loss, and achieve better cost-effectiveness.

[1]  E. Laasonen,et al.  Volume growth rate of acoustic neurinomas , 2004, Neuroradiology.

[2]  M. Richardson.  Pathology of skull base tumors. , 2001, Otolaryngologic clinics of North America.

[3]  M. Rutigliano,et al.  Cost effectiveness analysis: a review. , 1995, Neurosurgery.

[4]  T. Shaw.  IDENTIFYING HEALTH CARE COST CRISES IN OECD NATIONS , 2000 .

[5]  R. Foote,et al.  The Evolving Role of Stereotactic Radiosurgery for Patients with Skull Base Tumors , 2004, Journal of Neuro-Oncology.

[6]  A S Detsky,et al.  Surgery versus stereotactic radiosurgery for small, operable cerebral arteriovenous malformations: a clinical and cost comparison. , 1997, Neurosurgery.

[7]  Stereotactic Radiosurgery for Brain Metastasis , 2002 .

[8]  C. Vollmar,et al.  Direct costs of microsurgical management of radiosurgically amenable intracranial pathology in Germany: an analysis of meningiomas, acoustic nEuromas, metastases and arteriovenous malformations of less than 3 cm in diameter , 2003, Acta Neurochirurgica.

[9]  Seward Wf.  National health expenditures. , 1998 .

[10]  M. Mehta.  The physical, biologic, and clinical basis of radiosurgery. , 1995, Current problems in cancer.

[11]  D. Nelson,et al.  Quality of life and neuropsychological evaluation for patients with malignant astrocytomas: RTOG 91-14. Radiation Therapy Oncology Group. , 1997, International Journal of Radiation Oncology, Biology, Physics.

[12]  H. Königsmaier,et al.  The Costs of Radiosurgical Treatment: Comparison Between Gamma Knife and Linear Accelerator , 1998, Acta Neurochirurgica.

[13]  G. Pendl,et al.  Radiosurgery of Vestibular Schwannomas: A Minimally Invasive Alternative to Microsurgery , 1999, Acta Neurochirurgica.

[14]  R. Young.  RADIOSURGERY FOR THE TREATMENT OF BRAIN METASTASES , 1998 .

[15]  J. Bederson,et al.  Conservative treatment of patients with acoustic tumors. , 1991, Neurosurgery.

[16]  Andrew T. Huang,et al.  Insuring Taiwan's Health , 2001 .

[17]  L D Lunsford,et al.  The cost effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of solitary metastatic brain tumors. , 1995, Neurosurgery.

[18]  Taylor Murray,et al.  Cancer statistics, 1998 , 1998, CA: a cancer journal for clinicians.

[19]  G. Noren,et al.  Stereotactic Radiosurgical Treatment of Acoustic Neurinomas , 1988 .

[20]  K. Bulsara,et al.  Skull Base Surgery for Benign Skull Base Tumors , 2004, Journal of Neuro-Oncology.

[21]  D. Nelson,et al.  Quality of life and neuropsychological evaluation for patients with malignant astrocytomas: RTOG 91-14 , 1997 .

[22]  H. Nijs,et al.  Costs and effects of microsurgery versus radiosurgery in treating acoustic neuroma , 1997, Acta Neurochirurgica.

[23]  D. Kondziolka,et al.  Outcome Analysis of Acoustic Neuroma Management: A Comparison of Microsurgery and Stereotactic Radiosurgery: 215 , 1995, Neurosurgery.

[24]  M. Mehta,et al.  A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases. , 1997, International journal of radiation oncology, biology, physics.

[25]  T W Kaulich,et al.  [Gamma knife versus stereotactic linear accelerator. Utilization, clinical results and cost-benefit relations]. , 1996, Der Radiologe.

[26]  M E Epstein,et al.  Cost accounting the Gamma Knife. , 1993, Stereotactic and functional neurosurgery.

[27]  M. Rutigliano.  Cost Effectiveness AnalysisA Review , 1995 .