title: Comparative analysis of cost of endoscopic endonasal minimally invasive and sublabial-transseptal approaches to the pituitary.
abstract: BACKGROUND
  Two surgical approaches to the pituitary are commonly used: the sublabial-transseptal (SLTS) approach using microscopy and the endonasal endoscopic minimally invasive (MIPS) approach. Although outcomes are similar for both procedures, MIPS has become increasingly prevalent over the last 15 years. Limited cost analysis data comparing the 2 alternatives are available.
  
  
  METHODS
  A retrospective analysis of cost and volume data was performed using data from the published literature and University of North Carolina at Chapel Hill (UNC) Hospitals. A sensitivity analysis of the parameters was used to evaluate the uncertainty in parameter estimates.
  
  
  RESULTS
  The total cost in real dollars ranges from $11,438 to $12,513 and $18,095 to $21,005 per patient per procedure for MIPS and SLTS, respectively, with a cost difference ranging between $5582 and $9567 per patient per procedure. The sensitivity analysis indicates that the total cost for MIPS is most sensitive to: (1) average length of stay, (2) nursing costs, and (3) number of total complications, whereas the total cost for SLTS is most sensitive to: (1) average length of stay, (2) nursing cost, and (3) operating time. MIPS is less costly than SLTS between 94% and 98% of the time.
  
  
  CONCLUSIONS
  The results indicate that MIPS is less costly than SLTS at a large academic center. Future research should compare the outcomes and quality of life (QoL) associated with the 2 surgeries to improve the data used to determine the cost-effectiveness of MIPS compared to SLTS.
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Nadine
authors.initials: N
authors.lastname: Oosmanally
authors.forename: John E
authors.initials: JE
authors.lastname: Paul
authors.forename: Adam M
authors.initials: AM
authors.lastname: Zanation
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Ewend
authors.forename: Brent A
authors.initials: BA
authors.lastname: Senior
authors.forename: Charles S
authors.initials: CS
authors.lastname: Ebert
mesh_terms: D003362:Cost-Benefit Analysis; D004724:Endoscopy / Q000191:economics*; D006295:Health Resources / Q000191:economics; D006801:Humans; D007902:Length of Stay; D009296:Nasal Cavity / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000191:economics / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies