Introduction: There is a growing demand for cost-effectiveness analyses to evaluate microsurgical resection and radiosurgery for the treatment of vestibular schwannomas. We evaluate the specific cost drivers of each using the Value Driven Outcome database.
Methods: The authors retrospectively reviewed clinical and cost variables for all cases involving microsurgical and radiosurgical treatment of vestibular schwannomas from November 2011 to September 2017.
Results: We identified 163 vestibular schwannoma cases, including 116 managed microsurgically and 47 addressed with stereotactic radiosurgery (SRS). There were significant differences between the two groups in age, tumor size, and preoperative Koos grade (p<0.05) suggesting indications for treatment were markedly different. Length of stay and length of follow-up were also significantly different. Facility costs were the most significant contributor to both microsurgical and SRS groups (58.3% and 99.4%), however physician professional fees were not specifically analyzed. As expected, microsurgical treatment resulted in an average fourfold greater overall cost of treatment for open surgery cases (p<0.05), and there was a greater variation in costs for open cases as well. Costs remained stable over time for both open resection and SRS. Multivariable analysis showed that length of stay (ß=0.7, p=0.0001), discharge disposition (ß=0.2, p=0.004), nonserviceable hearing (ß=0.1, p=0.02), and complications (ß=0.2, p=0.005) affected cost for open surgery whereas no specifically examined factor could be identified as driving costs for SRS.
Conclusions: This analysis identified that facility utilization constitutes the majority of total costs for both microsurgery and SRS treatment modalities of vestibular schwannomas. LOS, discharge disposition, nonserviceable hearing, and complications contributed significantly to the total costs for the microsurgical group, while none of the factors contributed to the SRS group. This information may be used to establish policies and protocols to reduce facility costs with the goal of decreasing the total costs without jeopardizing patient care.
Patient Care: This work will improve understanding of treatment costs for patients with vestibular schwannomas, which should be more frequently considered during the overall course of clinical care.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the differences in cost drivers for the treatment of vestibular schwannomas by surgery or radiosurgery