Direct costs of microsurgical management of radiosurgically amenable intracranial pathology in Germany: an analysis of meningiomas, acoustic neuromas, metastases and arteriovenous malformations of less than 3 cm in diameter.

BACKGROUND: The purpose of the analysis was to appreciate and compare the effective direct costs of microsurgical treatment of intracranial pathology potentially amenable to radiosurgery as they arose in 1998-99.
METHOD: Treatment costs of 127 microsurgically treated patients harbouring an arteriovenous malformation (AVM), acoustic nEuroma, meningioma or brain metastasis potentially amenable to radiosurgery were reviewed. Costs for the surgical procedure, ICU care, medical and nursing care on the ward, interclinical bills (ICB) for services provided by other departments and the overhead for basic hotel service were added. For comparison Gamma Knife costs were calculated by dividing the global operating cost of the Gamma Knife centre by the number of patients treated in 1999.
FINDINGS: Average hospitalisation time for the entire microsurgical patients was 15,4+/-8,6 days. The patients spent an average of 1,2+/-2,8 days on ICU. Average operating time for all patients, including preparation, was 393+/-118 minutes. Average costs for the microsurgical therapy were Euro10.814+/-6.108. These consisted of Euro1417+/-426 for the surgical procedure, Euro1.188+/-2.658 for ICU care, Euro2.333+/-1.582 for medical and nursing care on the ward, Euro1.671+/-1.433 for interclinical bills and Euro 4.204+/-2.338 for basic hotel service (overhead, Euro273/day). 70% of the microsurgically treated patients needed ancillary inpatient rehabilitation or radiotherapy resulting in an average additional cost for all patients of Euro2.744. Furthermore 20% of the microsurgically treated patients required an unplanned readmission after discharge, resulting in an average additional costs for all patients of Euro1.684. Average overall costs per patient including ancillary therapy and unplanned readmissions amounted to Euro15.242. For comparison, Gamma Knife treatment costs per patient amounted to Euro7.920 in 1999.
INTERPRETATION: The current analysis showed that for established radiosurgical indications the primary costs of microsurgery exceeded the costs of radiosurgery. Differences with regard to additional expenses as a consequence of disability were not addressed in this study. Microsurgical management as well as Gamma Knife radiosurgery have potential for economic improvement.