Preferences and Utilities for Health States after Treatment of Olfactory Groove Meningioma: Endoscopic vs Open

Background: Olfactory groove meningiomas (OGMs) have been treated with either transcranial approaches such as the bifrontal craniotomy or more recently, with the endonasal endoscopic approach. Preliminary outcomes for the endonasal approach seem promising. In choosing an appropriate approach, clinicians must weigh the indications for the approach, potential clinical outcomes, and resource implications. The purpose of this study is to report utility scores for various health states after treatment for OGM to allow for economic comparisons and better understanding of society’s treatment preferences.

Methods: Fifty healthy subjects with no history of a malignant diagnosis were recruited. A trained interviewer reviewed scenarios describing treatment (Endoscopic, Open, Radiotherapy, watchful waiting), remission, recurrence and complications associated with the management of OGMs. The time-trade off (TTO) technique was used to derive utility scores for health states related to each treatment. Statistical analysis of utility scores were compared using non-parametric Kolmogorov-Smirnov testing, with multivariate analysis for demographic variability.

Results: Endoscopic resection had a higher mean utility score than a bifrontal craniotomy approach (0.88 vs 0.74, p = 0.01) and watchful waiting (0.88 vs 0.74, p = 0.03), but similar utility scores to radiotherapy (0.88 vs 0.92, p = 0.10). There was no difference in mean utility scores between bifrontal craniotomy and watchful waiting (p = 0.69), but both had lower utility scores compared with radiotherapy (p < 0.01, p < 0.01). For recurrent tumors, revision endoscopic resection had higher mean utility than revision craniotomy (0.79 vs 0.68, p = 0.02), but lower utility than radiotherapy (0.79 vs 0.87, p < 0.01).

Conclusion: This preliminary study demonstrates patient preference for an endoscopic approach compared with an open approach where indicated. We present health state utilities for common health states following the management of OGM that may be used for future cost-utility analyses.