Intracranial meningioma treatment cost

Understanding the costs of microsurgical or radiosurgical intracranial meningioma treatment may offer direction in reducing healthcare costs and establishing cost-effective algorithms.

Abou-Al-Shaar et al., from the Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, used the Value-Driven Outcome (VDO) database, which identifies cost drivers and tracks changes over time, to evaluate cost drivers for management of intracranial meningioma.

A single-center, retrospective cohort of patients undergoing microsurgical or radiosurgical treatment of intracranial meningiomas from July 2011 to April 2017 was analyzed. Patient and tumor characteristics, subcategory costs, and potential cost drivers were analyzed within each treatment modality.

Of 268 intracranial meningiomas treated, 198 were managed microsurgically and 70 with stereotactic radiosurgery (SRS). Facility costs were the largest contributor to total costs for microsurgery (59.7%), whereas imaging costs were the largest contributor to SRS total costs (98.2%). Patients with tumors in non-skull base locations had larger tumors (3.7±1.9 vs. 2.7±1.2 cm, p=0.0001) and were more likely to undergo microsurgery (81.7% vs. 55.2%) than patients with skull base tumors. Univariable analysis suggested that ASA Score, length of stay, discharge disposition, and maximal tumor size impacted cost during microsurgery (p=0.001) but only LOS (p=0.0001) and maximal tumor size (p=0.01) were drivers of total costs on multivariate analysis. For radiosurgery, age significantly affected cost in univariable (p=0.001) and multivariate analysis (p=0.003).

Implementing protocols to reduce facility utilization and imaging would mitigate total costs and improve resource utilization, while maintaining high-quality patient care. Additional cost effectiveness studies evaluating patients with true therapeutic equipoise will provide further guidance in these efforts ¹⁾.