title: Cost-utility of maximal safe resection of WHO grade II gliomas within eloquent areas.
abstract: 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.
authors.affiliation: Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla and Instituto de Formación e Investigación Marqués de Valdecilla, Av de Valdecilla s/n, Santander, Cantabria, Spain. juan.martino@hotmail.com
authors.forename: Juan
authors.initials: J
authors.lastname: Martino
authors.forename: Elsa
authors.initials: E
authors.lastname: Gomez
authors.forename: José L
authors.initials: JL
authors.lastname: Bilbao
authors.forename: Juan C
authors.initials: JC
authors.lastname: Dueñas
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vázquez-Barquero
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000191:economics*; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003399:Craniotomy / Q000191:economics*; D018572:Disease-Free Survival; D004558:Electric Stimulation; D005260:Female; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013030:Spain; D016896:Treatment Outcome; D055815:Young Adult