| Summary: | 碩士 === 臺中健康暨管理學院 === 健康管理研究所 === 93 === Objective: The aim of this study was to evaluate the relative costs of benign skull base tumors treated with open surgery and gamma knife radiosurgery.
Materials and Methods: In a retrospective study in China Medical University Hospital, we studied 174 patients with benign skull base tumors, less than 3 cm in diameter (or volume less than 30 ml), admitted in the past 4 years. Group A (n=94) underwent open surgery for removal of the tumors while group B (n=80) underwent gamma knife radiosurgery. The total costs were evaluated by both direct and indirect cost. The direct costs comprised intensive care unit (ICU) cost, ward cost, operating room (OR) cost, and outpatient visiting cost. The indirect costs included workless cost and mortality cost. The length of hospital stay, the length of workless day, surgical complications, mortality, and cost-effectiveness were calculated too. Student t-test and Chi-square test were employed for statistical analysis.
Results: The mean length of hospital stay for open surgery was 18.2 ±30.4 days including 5.0 ±14.7 days of ICU stay and 13.0 ±15.2 days of ward stay. The mean hospital stay for gamma knife was 2.2 ±0.9 days with no need of ICU stay, (open surgery vs. gamma knife, P<0.01). The mean workless day for open surgery was 119 ±142 days and 7.6 ±6.4 days for gamma knife, (open surgery vs. gamma knife, P<0.01). The gamma knife cost per hour (1,435 USD) is higher than the open surgery cost per hour (450 USD), P<0.01. The direct cost for gamma knife (9,460 ±6,691 USD) is higher than that for open surgery (5,530 ±5,597 USD), P<0.01. The hospital benefit was more of a negative balance for gamma knife (-4,830 ±4,263 USD) than for open surgery (-960 ± 5,325 USD), P<0.05. Open surgery had more complication rates (31.2%) than gamma knife (3.8%). Open surgery had a mortality rate of 5.3%; there was no mortality for gamma knife. The indirect costs, including workless cost and mortality cost, were significantly higher for open surgery than for gamma knife, P<0.01. Finally, the total cost (9,812 ±6,981 USD) is higher for open surgery than for gamma knife (23,338 ±95,253 USD), P<0.01. The cost-effectiveness for gamma knife (15 USD/day) is better than for open surgery (44 USD/day), P<0.01. It is pretty meaningful when the cost-effectiveness of socioeconomic cost for gamma knife (15 USD/day) is lower than the cost of working day (36.5 USD/day of our GDP).
Conclusions: Most of the costs loss with open surgery for benign skull base tumors comes from the indirect costs of workless days and mortality loss. Gamma knife radiosurgery is still a worthwhile treatment to our patients and to our society because it may shorten hospital stays and workless days and reduce complications, mortality, socio-economic loss, and achieve better cost-effectiveness.
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