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

• Published in: World neurosurgery 2017-09, Vol.105, p.818-823
• Main Authors: Karsy, Michael, MD, PhD, Brock, Andrea A., MD, MSCI, Guan, Jian, MD, Erica F. Bisson, MD, MPH, Couldwell, William T., MD, PhD
• Format: Article
• Language: English
• Subjects: Adenoma - surgery; Adult; Aged; Aged, 80 and over; Cost-effectiveness; Databases, Factual; Female; Health Care Costs; Humans; Length of Stay - economics; Male; Middle Aged; Neurosurgery; Neurosurgical Procedures - economics; Neurosurgical Procedures - methods; Pituitary Neoplasms - economics; Pituitary Neoplasms - surgery; Pituitary tumor; Retrospective Studies; Transsphenoidal surgery; Value-driven outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.05.148

Abstract Introduction Reducing healthcare costs while improving quality of care has become imperative in neurosurgical care. The Value-Driven Outcome (VDO) database at the University of Utah is one approach that identifies cost drivers and tracks changes over time. Methods A retrospective review by 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 A total of 272 patients (mean age 51.5±17.7 years, 45.6% male) with a mean length of stay of 4±4 days were 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 ten outlier patients accounted for 18.7% of total costs (mean cost for all patients: 0.24±0.29%). Discussion The results of this study 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 accounted a stronger cost driver than any other aspect of care. Various strategies to mitigate cost including stratifying low-risk patients to an intermediate care unit and reducing length of stay.