Is Expanded Endoscopic Sinus Surgery Cost-Effective Compared to Open Surgical Approaches for Olfactory Groove Meningiomas: A Cost-Utility Analysis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".