Comparative Cost Analysis of Endoscopic versus Microscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

Abstract

This study presents a comparative analysis of cost efficacy between the microscopic and endoscopic transsphenoidal approaches, evaluating neurological outcome, extent of resection (EOR), and inpatient hospital costs. This study was a retrospective chart review. This study was conducted at a tertiary care center. The study group consisted of 68 patients with transsphenoidal surgeries between January 2007 and January 2014. Two-sample -tests and Pearson's chi-square test evaluated inpatient costs, quality-adjusted life years (QALYs), volumetric EOR, and neurological outcomes. Total inpatient costs per patient was $22,853 in the microscopic group and less ($19,736) in the endoscopic group ( = 0.049). Operating room costs were $5,974 in the microscopic group and lower in the endoscopic group ($5,045; = 0.038). Operative time was 203.6 minutes in the microscopic group and 166.3 minutes in the endoscopic group ( = 0.032). The QALY score, length of hospital stay, and postoperative outcomes were found to be similar between the two cohorts. Multivariate linear regression modeling suggested that length of stay ( < 0.001) and operative time ( = 0.008) were important factors that influenced total inpatient costs following transsphenoidal surgery. This study shows that transsphenoidal surgery is more cost effective with the endoscopic approach than with the microscopic approach and depends on efficiency in the operating room as well as reduction in the length of hospitalization.

Predicting prolonged length of stay after endoscopic transsphenoidal surgery for pituitary adenoma

“…Coinciding with increased use of the endoscopic approach is the emphasis on decreased cost of care―a measure where decreased LoS can make a palpable impact 5,6 . In this study we attempted to better identify risk factors associated with increased LoS by utilizing a single‐institution database that would be the largest to date.…”

ICAR: endoscopic skull‐base surgery

“…The authors concluded that EEA was the most cost‐effective treatment strategy in the long term . Other authors have reported the cost‐benefit of EEA over other interventions but the level of data is substantially less due to the deficiency of sensitivity analyses …”

“…In terms of resource utilization drivers, most published studies agree that length of hospital stay (LOS), hospital/nursing care, as well as operating room time contribute most to overall costs related to EEAs and microscopic approaches to the pituitary . Other variables reported to influence costs were a diagnosis of Cushing's, surgeon volume, hospital characteristics, and postoperative complications …”

“…Analogous to the early applications of the endoscope used to approach the skull base, the vast majority of the current cost data report those associated with transsphenoidal sellar approaches, primarily between the use of microscopic and endoscopic techniques . Other studies have examined costs associated with endoscopic endonasal resection of meningiomas, sinonasal malignancies, as well as intra‐arachnoidal pathology .…”

Endoscopic Skull Base Surgery in Assiut University, Single Center Early Experience

“…Decrease the Hospital stay and lowering complication rate are the main rea-Open Journal of Modern Neurosurgery sons the make endoscopic skull base surgery has a more cost effectiveness than microscopic and cranial approaches for management of the same skull base lesions [11].…”