1378. Cost Containment Across Multiple Neurosurgical Procedures Using the Value-Driven Outcomes Database

Authors: Jared C Reese; Spencer Twitchell, BS; Herschel Wilde, BS; Jian Guan, MD; Mohamad Azab, MD; Michael Karsy, MD, PhD; William Couldwell, MD, PhD (Salt Lake City, UT)

Introduction: The evolving nature of our healthcare system demands an attention to the value of care provided. A novel tool known as the Value Driven Outcomes (VDO) database has the ability to determine actual costs, not charges, that complex reimbursement pathways otherwise obscure in the analytical process. Although cost-effectiveness analysis in neurosurgery has recently become popular, cross-comparison of neurosurgical procedures has yet to be fully evaluated. Methods: The VDO database was queried to evaluate elective surgeries between July 2011 through February 2018 involving vestibular schwannomas, pituitary adenomas, meningiomas, gliomas, aneurysms, 1- and 2-level lumbar fusions, and 1- to 3-level anterior cervical discectomy and fusion (ACDF) according to their respective common procedural terminology codes. Results: A total of 1997 patients (mean age 54.6 ± 14.5 years, 45.2% male) met the inclusion criteria for this study. An overall length of stay of 4.0 ± 4.4 days was observed. The distribution of total cost was largely accounted for by facility utilization (48.4%), followed by supplies and implants (35.8%), pharmacy (9.1%), imaging (3.5%), and laboratory services (3.1%). In cases where hardware was utilized, including both spine and vascular subgroups, supplies and implants became the principal cost. In cases involving tumor resection subgroups, facility utilization became the principal cost. Less than 20% of the total cost for both hardware and tumor cases was comprised of laboratory, imaging, and pharmacy costs. A multivariate linear regression showed that length of stay (β=0.7, p<0.001) and treatment type (β=0.2, p<0.001) played the strongest role in determining cost. Conclusion: Strategies to improve the value of healthcare should aim to reduce costs by targeting high price areas. These results suggest that the greatest potential effect on cost containment in neurosurgical care can be achieved by a reduction in facility utilization costs, followed by negotiating purchase pricing for supplies and implants.