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

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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.


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.


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).


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.



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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.


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