Socioeconomic Costs of Open Surgery and Gamma Knife Radiosurgery for Benign Cranial Base Tumors

Abstract

OBJECTIVE: The aim of this study was to evaluate the relative socioeconomic costs of benign cranial base tumors treated with open surgery and gamma knife radiosurgery. METHODS: In a retrospective study, we studied 174 patients with benign cranial base tumors, less than 3 cm in diameter (or volume less than 30 ml), admitted in the past 5 years. Group A (n = 94) underwent open surgery for removal of the tumors, whereas Group B (n = 80) underwent gamma knife radiosurgery. The socioeconomic costs were evaluated by both direct and indirect cost. The direct costs comprised intensive care unit cost, ward cost, operating room cost, and outpatient visiting cost. The indirect costs included loss of workdays and mortality. The length of hospital stay, the number of lost workdays, surgical complications, mortality, and cost-effectiveness analysis were calculated as well. Student t test and χ2 test were used for statistical analysis. RESULTS: The mean length of hospital stay for open surgery was 18.2 ± 30.4 days including 5.0 ± 14.7 days of intensive care unit stay and 13.0 ± 15.2 days of ward stay, P<0.01. The mean hospital stay for gamma knife was 2.2 ± 0.9 days with no need of intensive care unit stay, P<0.01. The mean loss of workdays for open surgery was 160 ± 158 days and 8.0 ± 9.0 days for gamma knife, P<0.01. The gamma knife cost per hour (US $1435) is higher than the open surgery cost per hour (US $450), P<0.01. The direct cost for gamma knife (US $9677 ± $6700) is higher than that for open surgery (US $5837 ± $6587), P<0.01. Open surgery had more complication rates (31.2%) than gamma knife (3.8%). Open surgery had a mortality rate of 5.3%; there was no mortality for gamma knife. The indirect costs, including loss of workdays and mortality, were significantly higher for open surgery than for gamma knife, P<0.01. Finally, the socioeconomic cost (US $34,453 ± $97,277) is higher for open surgery than for gamma knife (US $10,044 ± $7481), P<0.01. The CEA is significantly higher in gamma knife (US $3762/quality-adjusted life year) than in open surgery (US $8996/quality-adjusted life year), P<0.01. CONCLUSION: Most of the socioeconomic loss with open surgery for benign cranial base tumors comes from the indirect costs of workdays lost and mortality. Gamma knife radiosurgery is a worthwhile treatment to our patients and to our society because it may shorten hospital stays and workdays lost and reduce complications, mortality, socioeconomic loss, and achieve better cost-effectiveness.