Evaluation of cost and survival in intracranial gliomas using the Value Driven Outcomes database: a retrospective cohort analysis

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OBJECTIVE

Gliomas occur in 3–4 individuals per 100,000 individuals and are one of the most common primary brain tumors. Treatment options are limited for gliomas despite the progressive nature of the disease. The authors used the Value Driven Outcomes (VDO) database to identify cost drivers and subgroups that are involved in the surgical treatment of gliomas.

METHODS

A retrospective cohort of patients with gliomas treated at the authors’ institution from August 2011 to February 2018 was evaluated using medical records and the VDO database.

RESULTS

A total of 263 patients with intracranial gliomas met the authors’ inclusion criteria and were included in the analysis (WHO grade I: 2.0%; grade II: 18.5%; grade III: 18.1%; and grade IV: 61.4%). Facility costs were the major (64.4%) cost driver followed by supplies (16.2%), pharmacy (10.1%), imaging (4.5%), and laboratory (4.7%). Univariate analysis of cost contributors demonstrated that American Society of Anesthesiologists physical status (p = 0.002), tumor recurrence (p = 0.06), Karnofsky Performance Scale score (p = 0.002), length of stay (LOS) (p = 0.0001), and maximal tumor size (p = 0.03) contributed significantly to the total costs. However, on multivariate analysis, only LOS (p = 0.0001) contributed significantly to total costs. More extensive tumor resection in WHO grade III and IV tumors was associated with significant improvement in survival (p = 0.004 and p = 0.02, respectively).

CONCLUSIONS

Understanding care costs is challenging because of the highly complex, fragmented, and variable nature of healthcare delivery. Adopting effective strategies that would reduce facility costs and limit LOS is likely the most important aspect in reducing intracranial glioma treatment costs.

ABBREVIATIONS ASA = American Society of Anesthesiologists; EOR = extent of resection; GBM = glioblastoma; iMRI = intraoperative MRI; KPS = Karnofsky Performance Scale; LOS = length of stay; VDO = Value Driven Outcomes; 5-ALA = 5-aminolevulinic acid.

Article Information

Correspondence Randy L. Jensen: Clinical Neurosciences Center, University of Utah, Salt Lake City, UT. neuropub@hsc.utah.edu.

INCLUDE WHEN CITING Published online March 29, 2019; DOI: 10.3171/2018.12.JNS183109.

H.W. and M.A.A. contributed equally to this work.

Disclosures Dr. Jensen reports being a consultant for Medtronic.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Cost breakdown for the treatment of gliomas. Figure is available in color online only.

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    Cost breakdown by tumor and treatment characteristics. A: Costs by ASA status showed a significant difference for patients with incapacitating diseases compared with those with other statuses (p < 0.05). B: A significant difference in cost was seen depending on patient disposition (p < 0.05). C: Differences in cost were seen depending on tumor location between the parietal lobe and the brainstem (p < 0.05), as well as between the temporal lobe and the brainstem (p < 0.05). D: No significant difference in cost was seen in iMRI use or nonuse (p = 0.3). E: A difference in cost was seen between WHO grade I and WHO grade III (p < 0.05). F: No cost difference was seen based on the EOR (p = 0.9).

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    Patient survival by WHO grade and EOR. A: WHO grade II tumors showed no difference in survival depending on resection volume (p = 0.7). B: WHO grade III tumors showed a significant improvement in survival with increased tumor resection (p = 0.004). C: WHO grade IV tumors showed a significant improvement in survival with increased tumor resection (p = 0.02). D: Evaluation of patient cost versus survival for all tumors showed that most costs were clustered with short survivals. Survival status at last follow-up is shown. Figure is available in color online only.

References

  • 1

    Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group: Alternative Payment Model (APM) Framework: Final White Paper2016. Health Care Payment Learning & Action Network (https://hcp-lan.org/workproducts/apm-whitepaper.pdf)[Accessed January 16 2019]

  • 2

    Bernard-Arnoux FLamure MDucray FAulagner GHonnorat JArmoiry X: The cost-effectiveness of tumor-treating fields therapy in patients with newly diagnosed glioblastoma. Neuro Oncol 18:112911362016

  • 3

    Buckner JCShaw EGPugh SLChakravarti AGilbert MRBarger GR: Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med 374:134413552016

  • 4

    Butenschön VMIlle SSollmann NMeyer BKrieg SM: Cost-effectiveness of preoperative motor mapping with navigated transcranial magnetic brain stimulation in patients with high-grade glioma. Neurosurg Focus 44(6):E182018

  • 5

    DeWitt JCJordan JTFrosch MPSamore WRIafrate AJLouis DN: Cost-effectiveness of IDH testing in diffuse gliomas according to the 2016 WHO classification of tumors of the central nervous system recommendations. Neuro Oncol 19:164016502017

  • 6

    Eljamel MSMahboob SO: The effectiveness and cost-effectiveness of intraoperative imaging in high-grade glioma resection; a comparative review of intraoperative ALA, fluorescein, ultrasound and MRI. Photodiagn Photodyn Ther 16:35432016

  • 7

    Eseonu CIRincon-Torroella JReFaey KQuiñones-Hinojosa A: The cost of brain surgery: awake vs asleep craniotomy for perirolandic region tumors. Neurosurgery 81:3073142017

  • 8

    Floeth FWPauleit DSabel MStoffels GReifenberger GRiemenschneider MJ: Prognostic value of O-(2-18F-fluoroethyl)-L-tyrosine PET and MRI in low-grade glioma. J Nucl Med 48:5195272007

  • 9

    Glantz MChamberlain MLiu QLitofsky NSRecht LD: Temozolomide as an alternative to irradiation for elderly patients with newly diagnosed malignant gliomas. Cancer 97:226222662003

  • 10

    Guan JKarsy MBisson EFCouldwell WT: Patient-level factors influencing hospital costs and short-term patient-reported outcomes after transsphenoidal resection of sellar tumors. Neurosurgery 83:7267312018

  • 11

    Henaine AMPaubel NDucray FDiebold GFrappaz DGuyotat J: Current trends in the management of glioblastoma in a French University Hospital and associated direct costs. J Clin Pharm Ther 41:47–532016

  • 12

    Institute of Medicine Committee on the Learning Health Care System in America: Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press2013

  • 13

    Jiang SHill KPatel DWaldeck ARBotteman MAly A: Direct medical costs of treatment in newly-diagnosed high-grade glioma among commercially insured US patients. J Med Econ 20:123712432017

  • 14

    Karsy MBrock AAGuan JBisson EFCouldwell WT: Assessment of cost drivers in transsphenoidal approaches for resection of pituitary tumors using the Value-Driven Outcome Database. World Neurosurg 105:8188232017

  • 15

    Kubben PLter Meulen KJSchijns OEter Laak-Poort MPvan Overbeeke JJvan Santbrink H: Intraoperative MRI-guided resection of glioblastoma multiforme: a systematic review. Lancet Oncol 12:106210702011

  • 16

    Latif AZSignorini DGregor AWhittle IR: The costs of managing patients with malignant glioma at a neuro-oncology clinic. Br J Neurosurg 12:1181221998

  • 17

    McGirt MJChaichana KLAttenello FJWeingart JDThan KBurger PC: Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 63:7007082008

  • 18

    Mendez IJacobs PMacDougall ASchultz M: Treatment costs for glioblastoma multiforme in Nova Scotia. Can J Neurol Sci 28:61652001

  • 19

    Messali AVillacorta RHay JW: A review of the economic burden of glioblastoma and the cost effectiveness of pharmacologic treatments. Pharmacoeconomics 32:120112122014

  • 20

    Ostrom QTGittleman HLiao PVecchione-Koval TWolinsky YKruchko C: CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2010-2014. Neuro Oncol 19 (Suppl 5):v1v882017

  • 21

    Patterson H: Nobody Can Afford a Brain Tumor. The Financial Impacts of Brain Tumors on Patients and Families: A Summary of Findings. San Francisco: National Brain Tumor Foundation2007

  • 22

    Pickard JDBailey SSanderson HRees MGarfield JS: Steps towards cost-benefit analysis of regional neurosurgical care. BMJ 301:6296351990

  • 23

    Raizer JJFitzner KAJacobs DIBennett CLLiebling DBLuu TH: Economics of malignant gliomas: a critical review. J Oncol Pract 11:e59e652015

  • 24

    Ray SBonafede MMMohile NA: Treatment patterns, survival, and healthcare costs of patients with malignant gliomas in a large US commercially insured population. Am Health Drug Benefits 7:1401492014

  • 25

    Roa WBrasher PMBauman GAnthes MBruera EChan A: Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol 22:158315882004

  • 26

    Sathornsumetee SReardon DADesjardins AQuinn JAVredenburgh JJRich JN: Molecularly targeted therapy for malignant glioma. Cancer 110:13242007

  • 27

    Senft CBink AFranz KVatter HGasser TSeifert V: Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 12:99710032011

  • 28

    Senft CSeifert VHermann EFranz KGasser T: Usefulness of intraoperative ultra low-field magnetic resonance imaging in glioma surgery. Neurosurgery 63 (4 Suppl 2):2572672008

  • 29

    Smith JSChang EFLamborn KRChang SMPrados MDCha S: Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:133813452008

  • 30

    Spetzler RFKick SA: The status of neurosurgery in the United States: 2010 and beyond. World Neurosurg 74:32402010

  • 31

    Stupp RHegi MEMason WPvan den Bent MJTaphoorn MJJanzer RC: Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:4594662009

  • 32

    Undabeitia JTorres-Bayona SSamprón NArrázola MBollar AArmendariz M: Indirect costs associated with glioblastoma: experience at one hospital. Neurologia 33:85912018

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