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J Neurol Surg B Skull Base 2022; 83(01): 019-027
DOI: 10.1055/s-0040-1716672
Original Article

Health Care Utilization in Patients Undergoing Repeat Stereotactic Radiosurgery for Vestibular Schwannoma with 5-Year Follow-up: A National Database Analysis

Nicholas Dietz
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Mayur Sharma 
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Beatrice Ugiliweneza
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Dengzhi Wang
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Maxwell Boakye
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Brian Williams
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Norberto Andaluz
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
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Abstract

Background Stereotactic radiosurgery (SRS) has been used as an alternative to microsurgery in patients with small vestibular schwannoma (VS). We compare health care utilization metrics in patients undergoing repeat-SRS (re-SRS) and no repeat SRS (nr-SRS) at long-term follow-up.

Materials and Methods We queried the MarketScan database using International Classification of Diseases, Ninth Revision and Current Procedural Terminology 4, from 2000 to 2016. We included adult patients who had diagnosis of VS and treatment with SRS with at least 5 years of continuous enrollment after the procedure. Outcomes were hospital admissions, outpatient services, and medication refills.

Results Of 1,047 patients, 5.1% (n = 53) had repeat SRS. Majority of re-SRS (74%, n = 39) were done within 2 years of index procedure and 51% were within 1-year of initial procedure. Patients who required re-SRS incurred higher hospital readmission rate, outpatient services, and had higher payments compared with those who did not require re-SRS at 6 months, 1 year, and 2 years following the initial procedures. Re-SRS received 3.0- and 3.1-times higher payments at 1 and 2 years compared with nr-SRS cohort. At 5 years following SRS, median combined payments for re-SRS cohort was $105286 (interquartile range [IQR] $70999, $156569) compared with $44172 (IQR $22956, $84840) for nr-SRS cohort.

Conclusion More than half of the re-SRS procedures were noted within first year of initial SRS for VS. Overall payments at 5 years for repeat SRS was more than double that for nr-SRS. Repeat SRS was also associated with more re-admissions and outpatient services at annual follow-up time points.

Keywords

stereotactic radiosurgery - bundle payment - health care utilization - vestibular schwannoma


Publication History

Received: 26 December 2019

Accepted: 03 August 2020

Article published online:
10 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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