Supraorbital versus endoscopic endonasal approaches for olfactory groove meningiomas: a cost-minimization study.

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Supraorbital versus endoscopic endonasal approaches for olfactory groove meningiomas: a cost-minimization study.

World Neurosurg. 2017 Apr 10;:

Authors: Gandhoke GS, Pease M, Smith KJ, Sekula RF

Abstract
INTRODUCTION: We performed a cost-minimization study comparing the supraorbital and endoscopic, endonasal (EEA) approaches with or without the addition of craniotomy for the resection of olfactory groove meningioma.
METHODS: We built a decision tree using probabilities of gross total resection and CSF leak rates with the supraorbital approach versus EEA with and without additional craniotomy. The cost (not charge or reimbursement) at each 'stem' of this decision tree, for both surgical options was obtained from our hospital's finance department. After a base case calculation, we applied plausible ranges to all parameters and carried out multiple one-way sensitivity analyses. Probabilistic sensitivity analyses confirmed our results.
RESULTS: The probabilities of gross total resection (0.8) and CSF leak (0.2) for the supraorbital craniotomy were obtained from our series of five patients who underwent a supraorbital approach for resection of olfactory groove meningioma. Mean tumor volume was 54.6 cm(3), range (17 - 94.2 cm(3)). Literature reported rates of gross total resection (0.6) and CSF leak (0.3) with the EEA were applied to our economic analysis. Supraorbital craniotomy was the preferred strategy with an expected value of $29,423, compared to an EEA cost of $83,838. Applying multiple one-way sensitivity analysis, we found that the supraorbital craniotomy remained the preferred strategy with a minimum cost-savings of $46,000 to a maximum of $64,000. The probabilistic sensitivity analysis revealed the lowest cost difference between the 2-surgical options to be $37,431.
CONCLUSION: Compared to EEA, supraorbital craniotomy provides substantial cost-savings in the treatment of OGM. Given potential effectiveness differences between approaches, a cost-effectiveness analysis should be undertaken.

PMID: 28408255 [PubMed - as supplied by publisher]

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