Costs and Its Determinants in Pituitary Tumour Surgery

Alies J Dekkers; Friso de Vries; Amir H Zamanipoor Najafabadi; Emmy M van der Hoeven; Marco J T Verstegen; Alberto M Pereira; Wouter R van Furth; Nienke R Biermasz

doi:10.3389/fendo.2022.905019

Costs and Its Determinants in Pituitary Tumour Surgery

Front Endocrinol (Lausanne). 2022 Jul 7:13:905019. doi: 10.3389/fendo.2022.905019. eCollection 2022.

Authors

Alies J Dekkers^{1

2}, Friso de Vries^{1

2}, Amir H Zamanipoor Najafabadi³, Emmy M van der Hoeven⁴, Marco J T Verstegen^{2

3}, Alberto M Pereira^{1

2

5}, Wouter R van Furth^{2

3}, Nienke R Biermasz^{1

2}

Affiliations

¹ Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands.
² Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands.
³ Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, Leiden, Netherlands.
⁴ Directorate of Finances, Leiden University Medical Center, Leiden, Netherlands.
⁵ Department of Endocrinology and Metabolism, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, Netherlands.

Abstract

Purpose: Value-based healthcare (VBHC) provides a framework to improve care by improving patient outcomes and reducing healthcare costs. To support value-based decision making in clinical practice we evaluated healthcare costs and cost drivers in perioperative care for pituitary tumour patients.

Methods: We retrospectively assessed financial and clinical data for surgical treatment up to the first year after surgery of pituitary tumour patients treated between 2015 and 2018 in a Dutch tertiary referral centre. Multivariable regression analyses were performed to identify determinants of higher costs.

Results: 271 patients who underwent surgery were included. Mean total costs (SD) were €16339 (13573) per patient, with the following cost determinants: surgery time (€62 per minute; 95% CI: 50, 74), length of stay (€1331 per day; 95% CI 1139, 1523), admission to higher care unit (€12154 in total; 95% CI 6413, 17895), emergency surgery (€10363 higher than elective surgery; 95% CI: 1422, 19305) and postoperative cerebrospinal fluid leak (€14232; 95% CI 9667, 18797). Intradural (€7128; 95% CI 10421, 23836) and combined transsphenoidal/transcranial surgery (B: 38494; 95% CI 29191, 47797) were associated with higher costs than standard. Further, higher costs were found in these baseline conditions: Rathke's cleft cyst (€9201 higher than non-functioning adenoma; 95% CI 1173, 17230), giant adenoma (€19106 higher than microadenoma; 95% CI 12336, 25877), third ventricle invasion (€14613; 95% CI 7613, 21613) and dependent functional status (€12231; 95% CI 3985, 20477). In patients with uncomplicated course, costs were €8879 (3210) and with complications €17551 (14250).

Conclusions: Length of hospital stay, and complications are the main drivers of costs in perioperative pituitary tumour healthcare as were some baseline features, e.g. larger tumors, cysts and dependent functional status. Costs analysis may correspond with healthcare resource utilization and guide further individualized care path development and capacity planning.

Keywords: cost analysis; pituitary adenoma; pituitary surgery; pituitary tumour; transsphenoidal surgery; value-based healthcare.

MeSH terms

Adenoma* / surgery
Central Nervous System Cysts*
Humans
Neurosurgical Procedures
Pituitary Neoplasms* / surgery
Retrospective Studies