Cho Der-Yang, Tsao Meilan, Lee Wen-Yuan, Chang Cheng-Siu
Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan, Republic of China.
Neurosurgery. 2006 May;58(5):866-73; discussion 866-73. doi: 10.1227/01.NEU.0000209892.42585.9B.
The aim of this study was to evaluate the relative socioeconomic costs of benign cranial base tumors treated with open surgery and gamma knife radiosurgery.
In a retrospective study, we studied 174 patients with benign cranial base tumors, less than 3 cm in diameter (or volume less than 30 ml), admitted in the past 5 years. Group A (n = 94) underwent open surgery for removal of the tumors, whereas Group B (n = 80) underwent gamma knife radiosurgery. The socioeconomic costs were evaluated by both direct and indirect cost. The direct costs comprised intensive care unit cost, ward cost, operating room cost, and outpatient visiting cost. The indirect costs included loss of workdays and mortality. The length of hospital stay, the number of lost workdays, surgical complications, mortality, and cost-effectiveness analysis were calculated as well. Student t test and chi test were used for statistical analysis.
The mean length of hospital stay for open surgery was 18.2 +/- 30.4 days including 5.0 +/- 14.7 days of intensive care unit stay and 13.0 +/- 15.2 days of ward stay, P < 0.01. The mean hospital stay for gamma knife was 2.2 +/- 0.9 days with no need of intensive care unit stay, P < 0.01. The mean loss of workdays for open surgery was 160 +/- 158 days and 8.0 +/- 9.0 days for gamma knife, P < 0.01. The gamma knife cost per hour (1435 US dollars) is higher than the open surgery cost per hour (450 US dollars), P < 0.01. The direct cost for gamma knife (9677 US dollars +/- 6700 US dollars) is higher than that for open surgery (5837 US dollars +/- 6587 US dollars), P < 0.01. Open surgery had more complication rates (31.2%) than gamma knife (3.8%). Open surgery had a mortality rate of 5.3%; there was no mortality for gamma knife. The indirect costs, including loss of workdays and mortality, were significantly higher for open surgery than for gamma knife, P < 0.01. Finally, the socioeconomic cost (34,453 US dollars +/- 97,277 US dollars) is higher for open surgery than for gamma knife (10,044 US dollars +/- 7481 US dollars), P < 0.01. The CEA is significantly higher in gamma knife (3762 US dollars/quality-adjusted life year) than in open surgery (8996 US dollars/quality-adjusted life year), P < 0.01.
Most of the socioeconomic loss with open surgery for benign cranial base tumors comes from the indirect costs of workdays lost and mortality. Gamma knife radiosurgery is a worthwhile treatment to our patients and to our society because it may shorten hospital stays and workdays lost and reduce complications, mortality, socioeconomic loss, and achieve better cost-effectiveness.
本研究旨在评估采用开放手术和伽玛刀放射外科治疗良性颅底肿瘤的相对社会经济成本。
在一项回顾性研究中，我们研究了过去5年收治的174例直径小于3 cm（或体积小于30 ml）的良性颅底肿瘤患者。A组（n = 94）接受开放手术切除肿瘤，而B组（n = 80）接受伽玛刀放射外科治疗。通过直接成本和间接成本评估社会经济成本。直接成本包括重症监护病房成本、病房成本、手术室成本和门诊就诊成本。间接成本包括工作日损失和死亡率。还计算了住院时间、工作日损失数量、手术并发症、死亡率和成本效益分析。采用学生t检验和卡方检验进行统计分析。
开放手术的平均住院时间为18.2±30.4天，其中重症监护病房住院时间为5.0±14.7天，病房住院时间为13.0±15.2天，P<0.01。伽玛刀治疗的平均住院时间为2.2±0.9天，无需重症监护病房住院，P<0.01。开放手术的平均工作日损失为160±158天，伽玛刀治疗为8.0±9.0天，P<0.01。伽玛刀每小时成本（1435美元）高于开放手术每小时成本（450美元），P<0.01。伽玛刀的直接成本（9677美元±6700美元）高于开放手术（5837美元±6587美元），P<0.01。开放手术的并发症发生率（31.2%）高于伽玛刀（3.8%）。开放手术的死亡率为5.3%；伽玛刀治疗无死亡病例。包括工作日损失和死亡率在内的间接成本，开放手术显著高于伽玛刀，P<0.01。最后，开放手术的社会经济成本（34453美元±97277美元）高于伽玛刀（10044美元±7481美元），P<0.01。伽玛刀的成本效益分析（每质量调整生命年3762美元）显著高于开放手术（每质量调整生命年8996美元），P<0.01。
良性颅底肿瘤开放手术的大部分社会经济损失来自工作日损失和死亡率的间接成本。伽玛刀放射外科对我们的患者和社会来说是一种值得采用的治疗方法，因为它可以缩短住院时间和工作日损失，减少并发症、死亡率、社会经济损失，并实现更好的成本效益。
