EQ-5D Quality-of-Life Analysis and Cost-effectiveness after Skull Base Meningioma Resection

Background: Skull base meningioma management is complicated by their proximity to intracranial neurovascular structures because complete resection may pose a risk of worsening morbidity.

Objectives: To assess the influence of clinical outcomes and surgical management on patient-perceived quality-of-life outcomes, value, and cost-effectiveness.

Methods: Patients who underwent resection of a skull base meningioma, had adequate clinical follow-up, and completed EQ-5D-3L questionnaires preoperatively and at one month and one year postoperatively were identified in a retrospective review. Cost data from the Value Driven Outcomes database were analyzed.

Results: Fifty-two patients (83.0% women, mean age: 51.9 years) were categorized by worsened (n = 7), unchanged (n = 24), or improved (n = 21) EQ-5D-3L index scores at one-month follow-up. No difference in subcategory cost contribution or total cost was seen in the three groups ([Figs. 1] [2] [3]). Patients with improved scores showed a steady improvement through each follow-up period, whereas those with unchanged or worsened scores did not ([Fig. 4]). Mean quality-adjusted life years (QALY) and cost per QALY improved for all groups but at a higher rate for patients with better outcomes at 30-day follow-up. Female sex, non-frontotemporal approaches, optic nerve decompression, and absence of surgical complications correlated with improved EQ-5D-3L scores at 1-year follow-up. A mean cost per QALY of $27,731.06 ± 22,050.58 was observed for the whole group and did not significantly differ among patient groups (p = 0.1)

Conclusion: Patients undergoing surgical resection of skull base meningiomas who experience an immediate improvement in EQ-5D are likely to show continued improvement at 1 year, with improved QALY and reduced cost per QALY.

Fig. 1 Effect of patient characteristics on EQ-5D-3L scores. Mean (±SEM) EQ-5D-3L scores for patients (A) overall, (B) by age, (C) with or without tumor recurrence, and (D) by sex. *p < 0.05.

Fig. 2 Effect of patient symptoms on EQ-5D index score during follow-up period. Mean (±SEM) EQ-5D-3Lscores for patients with (A) vision change, (B) proptosis, (C) headaches, (D) ambulation deficits, (E) tinnitus, or (F) new cranial nerve deficits. *p < 0.05.

Fig. 3 Effect of surgical variables on EQ-5D index score during follow-up period. Mean (±SEM) EQ-5D-3L scores by (A) surgical approach, (B) optic nerve decompression occurrence, and (C) surgical complication result. *p < 0.05.

Fig. 4 EQ-5D index score, QALY, and cost per QALY depending on EQ-5D score changes. (A) Patients with improved EQ-5D-3L index scores (mean: 0.80 ± 0.19) at 30 days had significantly lower initial scores (mean 0.67 ± 0.23) than the other groups, and these patients also improved at 1 year (mean: 0.90 ± 0.14) (p < 0.05). At follow-ups #2 (1 year) and #3 (longer), EQ-5D-3L scores were not significantly different among groups. (B) Patients with improved outcomes showed the highest average QALY. There was a significant difference in QALYs at 1 year among groups (p = 0.04, one-way ANOVA), which resulted from the greater QALYs in the improved patient group. (C) Cost per QALY decreased over time for all patients. There was no difference in cost per QALY at follow-up time points. The overall mean cost per QALY at the last follow-up time point was $27,731.06 ± 22,050.58.