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.
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