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  • National and Regional Variation in Costs of Transsphenoidal Pituitary Surgery in the United States

    Final Number:

    Anthony O Asemota MD MPH; Masaru Ishii MD; Henry Brem MD; Gary L. Gallia MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Geographic variations in healthcare costs have been described across many specialties. There is paucity of data regarding the regional costs associated with transsphenoidal pituitary surgery in the US.

    Methods: Data from the Marketscan database from 2010-2014 was analyzed. We examined overall total payments, hospital/facility payments, physician reimbursements, and out-of-pocket expenses for patients undergoing microscopic and endoscopic transsphenoidal pituitary surgery. Average cost-estimates were obtained after risk-adjustment for confounders and estimated cost-differences were obtained.

    Results: The estimated average annual burden of transsphenoidal pituitary surgery was $42 million/year. The average regional overall total payments were as follows: North-east [$36,031.88±793.38], North-central [$35,894.78±853.60], South [$32,198.47±853.60], and West [$38,786.57±931.45]. The average regional hospital/facility costs were as follows: North-east [$26,042.80±700.42], North-central [$27,311.49±748.44], South [$24,512.22±585.83] and West [$30,357.86±816.71]. The average regional physician payments were as follows: North-east [$5,382.97±168.89], North-central [$4,994.42±180.47], South [$4,001.24±141.26], and West [$4,499.61±196.93]. The average regional out-of-pocket payments were as follows: North-east [$1,903.96±290.29], North-central [$2,403.94±289.10], South [$2,421.49±205.99], and West [$2,197.23±299.13]. Compared to the North-east, overall total and hospital/facility costs were higher in the West and lower in the South (both p<0.001), while physician reimbursements were lower in both the West and South (both p<0.001). There were no significant differences in out-of-pocket expenses across regions (p=0.76) (See Figures 1-4). At the national level, there were significantly higher overall total payments and hospital/facility payments associated with endoscopic compared to microscopic procedures (p<0.001). Multivariate models demonstrated that length of stay, health-plan, and post-surgical complications were among significant predictors of costs of transsphenoidal pituitary surgery (all p<0.001). Despite significant regional differences in proportion of network payers, there were overall similar out-of-pocket payments across regions.

    Conclusions: Our results demonstrate significant geographical disparities in costs associated with transsphenoidal pituitary surgery. Understanding factors underlying disparate costs is important for developing strategies to help control costs.

    Patient Care: By improving awareness on regional differences in costs as well as out of pocket costs and how this affects patients

    Learning Objectives: To improve awareness on healthcare costs


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