Is Expanded Endoscopic Sinus Surgery Cost-Effective Compared to Open Surgical Approaches for Olfactory Groove Meningiomas: A Cost-Utility Analysis

Background: This study is a health economic comparison between expanded endoscopic sinus approaches to open craniotomy approaches for the management of olfactory groove meningiomas (OGMs).

Methods: We adopted a hospital administrator perspective, and modeled the treatment for OGMs using decision tree analysis over a 1-year horizon. We included the complication of CSF leakage in our model and derived model parameters from hospital costing data, utilities from our own time trade-off utility study, and rates of complications and recurrences from a comprehensive literature review.

Results: In this base case analysis, the average cost of an endoscopic approach for olfactory groove meningioma resection was $20,376.55 (CAD) compared with $26,267.79 for open bifrontal craniotomy approaches for a cost savings of $5,891.24 per patient treated. Rates of CSF leakage postoperatively were 30 and 4% for endoscopic and open approaches respectively. The quality of adjusted life-expectancy over a 1-year horizon for endoscopic approach was 0.87 compared with 0.74 for an incremental effectiveness of 0.13 quality adjusted life year per patient treated. In this base case analysis, endoscopic approach dominated open approach with cost savings and incremental effectiveness, despite higher rates of postoperative CSF leakage.

Conclusion: Our initial base case analysis demonstrated that endoscopic approach is cost effective when compared with open approaches for resection of OGMs. This finding, though significant, should be interpreted carefully until long-term data including recurrence, and survival are incorporated. We plan to further develop our model to capture the impact of recurrences, further treatment and follow-up on the cost and utility of these treatment approaches.