Cost and Survival Analysis of Metastatic Cerebral Tumors Treated by Resection and Radiation

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Abstract
THE SURGICAL TREATMENT of metastatic brain tumors remains controversial, primarily because of the limited prognosis of patients with metastatic cancer. The cost effectiveness of even standard therapies is of increasing concern to third-party payers. We reviewed the records of patients who had a single metastatic brain tumor resected at the Medical Center Hospital of Vermont (a referral center in a rural state) since cost data recording began. The 32 patients ranged in age from 35 to 77 years, with a 2.2:1 female-to-male ratio. Thirty-four percent of tumors originated in the lung, 15.6% were renal, 12.5% were breast, 12.5% were gynecological, 9.4% were gastrointestinal, and 9.4% were ultimately of unknown origin. Thirty-one tumors were completely resected; 30 patients were irradiated, most after surgery (mean dose, 3,908 ± 1,250 cGy). Karnofsky scores improved from 80 ± 11 to 88 ± 16 postoperatively (P = 0.0038, one-tailed paired t-test). Patients were hospitalized an average of 8.22 ± 6.26 days postoperatively, with total operative and postoperative charges of $19,190 ± 5,684, noninclusive of radiotherapy. The expected median survival of all patients was 26 months (Kaplan-Meier estimate). The presence of disseminated disease was not significantly correlated with survival (P = 0.237). The number of postoperative days was more for patients with disseminated disease (P = 0.0274), but not for patients with infratentorial tumors (P = 0.6991). Age higher than the median was not correlated with an increased number of postoperative days (P = 0.1366) nor was a preoperative Karnofsky score of 70 or less (P = 0.1382). We believe that the cost of adding surgical therapy is not out of proportion to the degree of palliation achieved, especially because surgical treatment can result in rapidly improved function and long-term survivals are not uncommon. Factors suspected to influence the length of hospitalization such as age and tumor location do not affect postoperative stay and thus the cost of treatment.