Cost-utility of maximal safe resection of WHO grade II gliomas within eloquent areas

摘要

Background: Despite the growing use of intraoperative electrical stimulation (IES) mapping for resection of WHO grade II gliomas (GIIG) located within eloquent areas, some authors claim that this is a complex, time-consuming and expensive approach, and not well tolerated by patients, so they rely on other mapping techniques. Here we analyze the health related quality of life, direct and indirect costs of surgeries with and without intraoperative electrical stimulation (IES) mapping for resection of GIIG within eloquent areas. Methods: A cohort of 11 subjects with GIIG within eloquent areas who had IES while awake (group A) was matched by tumor side and location to a cohort of 11 subjects who had general anesthesia without IES (group B). Direct and indirect costs (measured as loss of labor productivity) and utility (measured in quality adjusted life years, QALYs), were compared between groups. Results: Total mean direct costs per patient were 38,662.70 (range 19,950.70 to 61,626.40) in group A, and 32,116.10 (range 22,764.50 to 46,222.50) in group B (p = 0.279). Total mean indirect costs per patient were 10,640.10 (range 3,010.10 to 86,940.70) in group A, and 48,804.70 (range 3,340.10 to 98,400.60) in group B (p = 0.035). Mean costs per QALY were 12,222.30 (range 3,801.10 to 47,422.90) in group A, and 31,927.10 (range 6,642.90 to 64,196.50) in group B (p = 0.023). Conclusions: Asleep-awake-asleep craniotomies with IES are associated with an increase in direct costs. However, these initial expenses are ultimately offset by medium and long-term costs averted from a decrease in morbidity and preservation of the patient's professional life. The present study emphasizes the importance to switch to an aggressive and safer surgical strategy in GIIG within eloquent areas.