Direct Healthcare Cost Analysis of Endoscopic Compared with Sublabial Transseptal Pituitary Surgery

Background and Methods: Completely endoscopic endonasal approaches to skull base pathology have rapidly gained popularity in recent years. Evidence of their safety and efficacy has begun to appear in the literature, and quality of life (QOL) data available to date also suggest comparable or improved outcomes compared with traditional approaches. However, data comparing costs of endoscopic skull base procedures and classic approaches are scarce. We considered the cost of minimally invasive pituitary surgery (MIPS) versus classic sublabial transseptal (SLTS) approaches. Expanded endonasal approaches were not included. Using real costs (rather than billed costs) associated with each surgery, cost effectiveness and sensitivity analyses were performed in conjunction with our School of Public Health.

Results: Total cost for MIPS was $11,438, and total cost for SLTS was $21,005. If narrower variability ranges are employed, the costs changed to $12,513 and $18,095, respectively. Thus, cost differences favor MIPS over SLTS by as much as $9,567 and a minimum of $5,582. Additionally, factors identified that contributed most to cost of the MIPS approach included length of stay, nursing cost, nursing time, and total number of complications. Monte Carlo simulation of 1000 case scenarios indicated that under a variety of conditions, MIPS remains less costly than SLTS 94–98% of the time.

Discussion: In the current healthcare milieu, cost analyses to justify the use of new techniques are paramount. Our data suggest that, at least in the case of pituitary resections, endoscopic procedures are cost effective as compared with traditional approaches. We discuss the difficulties of comparing expanded approaches given the inability to measure specific CPT codes and the variability in practice and pathologies treated. Further analysis must be done to compare endoscopic procedures for these highly heterogeneous non-pituitary skull base pathologies, but our data provide reassurance that endoscopic approaches have the potential to save valuable healthcare dollars.