301 Drivers and Components of Hospital Costs After Transsphenoidal Resection of Sellar Tumors

Abstract

Abstract INTRODUCTION Assessing treatment costs of transsphenoidal surgery for removal of sellar lesions can be complex. Few data are available regarding what contributes to higher costs after these procedures. The goals of this study were to clarify cost drivers in transsphenoidal sellar surgery, to determine what categories contributed the most to these costs, and to evaluate the relationship between expenditures and short-term patient-reported outcomes. METHODS The authors used a proprietary institutional database tool the Value Driven Outcomes database to review prospectively collected data on transsphenoidal sellar surgery over a nearly 5-year period. Hospital costs, demographic data, disease-specific variables, hospital-related measures, and patient-reported outcomes in the form of Euro-QoL-5D (EQ-5D) responses were collected for all patients. RESULTS >One hundred seventeen patients met the inclusion criteria. A multivariable logistic regression model for hospital costs showed a significant association between higher costs and adrenocorticotropic hormone secreting tumors (OR 30.409, 95% CI 2.695-343.121), larger tumor size (OR 1.084, 95% CI 1.026-1.146), and in-hospital complications (OR 4.209, 95% CI 1.268-13.968). The largest contributor to hospital costs in our cohort was facility cost (75%), followed by pharmacy (13%) and supply (7%) costs. Most patients (65.8%) had stable or improved EQ-5D responses at 1-month follow-up, with significantly lower preoperative EQ-5D scores than those who reported worsened quality of life (0.776 ± 0.209 vs. 0.867 ± 0.148, P = 0.015) and significantly higher postoperative EQ-5D scores (0.887 ± 0.144 vs. 0.759 ± 0.144, P < 0.001) on univariate analysis. CONCLUSION Most patients undergoing transsphenoidal surgery for sellar tumors experience stable or improved postoperative quality of life, even shortly after surgery. Factors associated with increased costs of surgery included larger tumor size and in-hospital complications. Using these data, further study can be directed at determining which interventions may improve the value of transsphenoidal surgery.