Authors: Ankush Chandra; Harsh Wadhwa, BS; Jonathan Rick, BS; Ishan Kanungo, BS; Ivan El-Sayed, MD; Lewis Blevins, MD; Manish Aghi, MD, PhD (San Francisco, CA)


Transsphenoidal surgery is the gold standard for treating most pituitary tumors and can be performed using microscopic (MTS) or endoscopic (ETS) approaches. We compared the economic burden and cost-effectiveness of the two approaches.


Retrospective review of patients with pituitary adenomas (2007-2013) undergoing surgical resection at our institution and corresponding in-patient hospital cost.


Of 192 patients (median age=47.2; females=54.2%), ninety (46.8%) underwent ETS while 102 (53.2%) underwent MTS. All ETS were done with OHNS assistance while MTS were done solely by neurosurgeons. Temporal trends revealed a gradual increase in the number of endoscopic surgeries, with 4.43 more cases every year (R-square=0.88, p=0.002), while there was a gradual decline in the number of microscopic surgeries by 1.2 cases per year (R-square=0.35, p=0.032). Tumor characteristics were similar between both cohorts. The endoscopic cohort had lower total in-patient hospital costs compared to the microscopic cohort ($26,805 versus $37,371, p=0.001). Categorical analysis revealed that ETS patients had lower room/board ($7,328.48 versus $9,866.27, p=0.01) and operative costs ($7,035.27 versus $9,129.61, p=0.02) than MTS patients, while cost associated with labs, imaging, in-hospital pharmacy, pathology or any inpatient treatments were similar in both groups. Postoperatively, the endoscopic cohort had shorter hospital stays versus microscopic patients (2.1 days versus 2.8 days; p=0.02). Progression-free survival (4.6 years vs 4.1 years, p=0.04) and QALY scores (3.7 vs 3.21, p=0.026) were significantly better for endoscopic patients than microscopic patients. The incremental cost per QALY was $21,563 lower for the endoscopic approach.


ETS was associated with lower hospital costs despite involving dual specialty co-surgeries, shorter stay in the hospital, and better QALY scores and progression-free survival. Multi-institutional validation of these findings could offer valuable information to centers considering transitioning to endoscopic approaches and could justify multidisciplinary co-surgeries to insurance payors who may inaccurately perceive these procedures to be costlier.