title: Analysis of Cost Variation in Craniotomy for Tumor Using 2 National Databases.
abstract: BACKGROUND
  There is a significant increase and large variation in craniotomy costs. However, the causes of cost differences in craniotomies remain poorly understood.
  
  
  OBJECTIVE
  To examine the patient and hospital factors that underlie the cost variation in tumor craniotomies using 2 national databases: the National Inpatient Sample (NIS) and Vizient, Inc. (Irving, Texas).
  
  
  METHODS
  For 41 483 patients who underwent primary surgery for supratentorial brain tumors from 2001 to 2013 in the NIS, we created univariate and multivariate models to evaluate the effect of several patient factors and hospital factors on total hospital cost. Similarly, we performed multivariate analysis with 15 087 cases in the Vizient 2012 to 2015 database.
  
  
  RESULTS
  In the NIS, the mean inflation-adjusted cost per tumor craniotomy increased 30%, from $23 021 in 2001 to $29 971 in 2013. In 2001, the highest cost region was the Northeast ($24 486 ± $1184), and by 2013 the western United States was the highest cost region ($36 058 ± $1684). Multivariate analyses with NIS data showed that male gender, white race, private insurance, higher mortality risk, higher severity of illness, longer length of stay, elective admissions, higher wage index, urban teaching hospitals, and hospitals in the western United States were associated with higher tumor craniotomy costs (all P < .05). Multivariate analyses with Vizient data confirmed that longer length of stay and the western United States were significantly associated with higher costs (P < .001).
  
  
  CONCLUSIONS
  After controlling for patient/clinical factors, hospital type, bed size, and wage index, hospitals in the western United States had higher costs than those in other parts of the country, based on analyses from 2 separate national databases.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.|Center for Healthcare Value, University of California, San Francisco, San Francisco, California.
authors.forename: Corinna C
authors.initials: CC
authors.lastname: Zygourakis
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Caterina Y
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Brown University, Providence, Rhode Island.
authors.forename: Seungwon
authors.initials: S
authors.lastname: Yoon
authors.affiliation: Center for Healthcare Value, University of California, San Francisco, San Francisco, California.|Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Christopher
authors.initials: C
authors.lastname: Moriates
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Christy
authors.initials: C
authors.lastname: Boscardin
authors.affiliation: Center for Healthcare Value, University of California, San Francisco, San Francisco, California.|Department of Medicine, University of California, San Francisco, San Francisco, California.|Philip Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California.
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Philip
authors.initials: P
authors.lastname: Theodosopoulos
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.affiliation: Center for Healthcare Value, University of California, San Francisco, San Francisco, California.|Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Ralph
authors.initials: R
authors.lastname: Gonzales
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000191:economics* / Q000601:surgery*; D003399:Craniotomy / Q000191:economics*; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States
keywords: Brain tumor; Cost of surgery; Cost variation; Craniotomy; Craniotomy for tumor; National Inpatient Sample (NIS) database; University health consortium (UHC); Vizient