Assessment of Cost Drivers in Transsphenoidal Approaches for Resection of Pituitary Tumors Using the Value-Driven Outcome Database

World Neurosurg. 2017 Sep:105:818-823. doi: 10.1016/j.wneu.2017.05.148. Epub 2017 Jun 2.

Abstract

Background: Reducing health care costs while improving quality of care has become imperative in neurosurgical care. The Value-Driven Outcome database at the University of Utah identifies cost drivers and tracks changes over time.

Methods: Retrospective review was performed for transsphenoidal resections of pituitary adenomas from July 2012 to September 2016. Total cost, subcategory costs, and potential cost drivers were evaluated.

Results: There were 272 patients (mean age 51.5 years ± 17.7, 45.6% male) with mean length of stay of 4 days ± 4 evaluated. Total costs included facility utilization (60%), physician professional fees (16%), pharmacy (11%), supplies and implants (7%), laboratory studies (5%), and imaging (1%). Facility costs were driven by neurocritical care unit (30.7%), neurosurgical operating room (16.6%), and neurosurgical floor (11.2%) costs. Multivariable linear regression, after adjusting for length of stay and American Society of Anesthesiologists grade, showed that overall cost was heavily influenced by facility utilization (ρ = 0.98, P = 0.001), pharmacy (ρ = 0.71, P = 0.001), supplies and implants (ρ = 0.51, P = 0.0001), imaging (ρ = 0.51, P = 0.0001), and laboratory (ρ = 0.79, P = 0.001) costs. The top 10 outlier patients accounted for 18.7% of total costs (mean cost for all patients 0.24% ± 0.29).

Conclusions: Our results highlight the importance of facility utilization and pharmaceutical, supply/implant, imaging, and laboratory costs as overall cost drivers during transsphenoidal pituitary tumor resection. Facility utilization was a stronger cost driver than any other aspect of care. Strategies to mitigate cost include stratifying low-risk patients to an intermediate care unit and reducing length of stay.

Keywords: Cost-effectiveness; Pituitary tumor; Transsphenoidal surgery; Value-driven outcome.

MeSH terms

  • Adenoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Female
  • Health Care Costs*
  • Humans
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Neurosurgical Procedures / economics*
  • Neurosurgical Procedures / methods
  • Pituitary Neoplasms / economics
  • Pituitary Neoplasms / surgery*
  • Retrospective Studies