Cost Analysis of Approaches to the Anterior Skull Base

Abstract

Objective: To ascertain 1) the cost-effectiveness and 2) short-term outcomes of endoscopic endonasal cribriform resection in comparison to open/subcranial approaches.

Method: Retrospective cohort study reviewing consecutive patients (2008-2011) undergoing primary surgical treatment for cribriform malignancies via endoscopic or open/subcranial approaches. All patients were reviewed to ensure feasibility of endoscopic approach. Outcomes based on complications and length of stay were reviewed, and cost to society was analyzed using QALYs. Sensitivity analyses were performed.

Results: Eight patients were treated for cribriform malignancies, 4 with an endoscopic endonasal approach, and 4 with an open surgical approach. The mean length of hospitalization following the first surgery did not differ significantly between the 2 groups (5.25 days endoscopic vs 5.5 days open; P = .92). Differences were seen in blood loss and length of surgery, but neither were statistically significant (blood loss: 275 mL endoscopic vs 1200 mL open; P = .27; and length of surgery: 314 min endoscopic vs 394.5 min open; P = .33). Costs of each surgical intervention and associated follow-up and specialized care appear equivocal.

Conclusion: Economic evaluations are the mainstay for determining cost effectiveness of an intervention, and this is the first such evaluation for endoscopic skull base surgery for anterior cribriform tumors. Though differences between the 2 approaches seem equivocal, this is likely due to the few patients who have received this intervention.