1387. Evaluation of Cost and Survival in Intracranial Gliomas Using the Value Driven Outcome Database: A Retrospective Cohort Analysis

Authors: Hussam Abou Al-Shaar, MD; Herschel Wilde, BS; Mohammed Azab, MD; Abdullah Abunimer, MD; Michael Karsy; Jian Guan, MD; Sarah Menacho, MD; Randy Jensen, MD (Bellerose Manor, NY)

Introduction: Using a management and reporting tool such as the Value Driven Outcomes (VDO) database enables surgeons to understand the subcategory costs of intracranial gliomas treatment. This understanding would result in delivering a higher-quality care, better treatment outcomes, fewer complications, and reduced health care expenditure. We utilized the VDO database to identify cost drivers that are involved in the management of gliomas. Also, we assessed patients’ survival following treatment of intracranial gliomas. Methods: A retrospective cohort of intracranial glioma patients treated at the University of Utah from August 2011 to February 2018 was evaluated. Patients’ age, sex, preoperative American Society of Anesthesiologists (ASA) physical status, tumor size and mutational status, length of stay (LOS), Karnofsky Performance Scale (KPS) index, tumor recurrence, and discharge disposition were analyzed. Results: A total of 263 patients with intracranial gliomas met our inclusion criteria and were included in the analysis. Facility costs were the major (64.4%) cost driver followed by supplies (16.2%), pharmacy (10.1%), imaging (4.5%), and laboratory (4.7%). Univariate analysis of cost contributors demonstrated that ASA status (p=0.002), tumor recurrence (p=0.06), KPS index (p=0.002), LOS (p=0.0001), and maximal tumor size (p=0.03) contributed significantly to the total costs. However, on multivariate analysis, only LOS (p=0.0001) contributed significantly to total costs. Increased tumor resection in WHO grade III and IV tumors is associated with significant improvement in survival (p=0.004, p=0.02, respectively). Conclusion: Understanding care costs is challenging due to the highly complex, fragmented, and variable nature of healthcare delivery. With the aid of several management and reporting tools, clinicians and health care systems have the greatest opportunity, the most knowledge, and the responsibility to improve health care value. Adopting effective strategies that would reduce facility costs and limit LOS are likely the most important aspects toward reducing intracranial glioma treatment costs.