Table 3 Variables used in the model
Name | Description | Comment | Root definition | Low | High |
|---|---|---|---|---|---|
Percent_GTR_Neuroblate | Percent of patients with a GTR deemed to be favorable for survival | Data derived from Mohammadi et al. [24] | 0.37 | 0 | 1 |
Percent_open_resection | Percent of patients where open cranitomy was performed for a subtotal resection | Data derived from Laws RE et al. [48] | 0.78 | 0 | 1 |
Cost_blended_DRG25_26 | Cost of craniotomy procedure for a patient with a high grade glioma—weighted average for DRGs 25–26 | CRANIOTOMY and ENDOVASCULAR INTRACRANIAL PROCEDURES W CC or MCC (Nat Aver)—weighted average based on frequency of procedurs in Medicare patients for the 2012 calendar year. HCUPNet source | $22,291 | 0 | 25,000 |
Cost_CPT_00210 | National average payment amount Medicare for anesthesia | Assumes surgical procedure to last at least 8 h, 30 min | $1012.50 | 0 | 1012.5 |
Cost_CPT_61799 | Stereotactic cranial lesion—complex | Cost of creation of an additional stereotactic lesion (each complex lesion) above and beyond that created by CPT 61798 (assume 3 additional lesions)—each lesion @ $325/lesion (Medicare national average payment rate for 2015 | $975 | 0 | 1406.76 |
Cost_CPT_61510 | National average payment Medicare for a craniotomy to remove a brain tumor | Craniotomy, trephination, for excision of a brain tumor | $2225 | 0 | 2225 |
Cost_CPT_99144 | Cost moederate sedation first 30 min | Cost for moderate sedation of patient first 30 min | $19.30 | 0 | 19.3 |
Cost_CPT_99145 | Cost moderate sedation each additional 15 min at a cost of $9.40 for each 15 time increment | $9.40s | 0 | 9.4 | |
Cost_CPT_61798 | National average payment amount Medicare for stereotactic radiosurgery | Paid as part of the LITT procedure along with CPT 61510 and CPT 61781 | $1408 | 0 | 1408 |
Cost_CPT_61800 | National average payment Medicare for headframe placement | 2015 national average payment rate for head frame placement used in stereotactic radiosurgery | $165 | 0 | 235 |
Cost_CPT_99233 | National average Medicare payment for E&M inpatient—subsequent patient visits | $105 | 0 | 105 | |
Cost_CPT_99222 | National average payment Medicare E&M care first patient visit | $138 | 0 | 138 | |
Average_LOS_surgery | Average length of hospital stay in days for patient having surgery in an eloquent area of the brain to remove a brain neoplasm | LOS_surgery_GBM | 0 | 6 | |
Average_LOS_LITT | Average length of hospital stay for patient having LITT surgery for brain tumor | 3 | 0 | 3 | |
Average_LOS_brain_biopsy | Average lengthe of hospital days for a brain biopsy—subtotal resection | Derived from 2012 HCUPNet inpatient data on ICD9CM 01.13 (closed biopsy brain) | 6 | 0 | 6 |
Local_recurrence_GBM | Recurrence GBM that progresses locally | Data derived from Pope WB et al. [49] | 0.77 | 0 | 1 |
Cost_Routine_Home_Hospice | Cost for routine home hospice care per day Medicare FY 2015 | $159 | 0 | 300 | |
Percent_palliative_care | Percent of patients eligible for palliative care based on surviving <6 months | Data derived from Park JK et al. [50] | 0.44 | 0 | 0.44 |
Cost_CMG_302 | Case mix group 302 for non-traumatic brain injury incurred during neurosurgery procedure. Surgery results in significant motor and cognitive deficits | Assumes patient has “severe” comorbidities and inpatient rehabilitation facility (IRF) is paid at national weighted average of $23,310 for CMG 302 Tier 1 and Tier 2 at the mix of DRG 25 (59 %) and DRG 26 (41 %) (FY 2015 rate for Medicare). Derived from Federal Register, Vol. 79; No. 151, August 6, 2014, page 45888 | $23,310 | 0 | 20,000 |
Cost_CPT_99220 | Observation care facility setting—initial visit; 2015 Medicare national average payment | Dervied from Medicare PPS FY 2015 | $188 | 0 | 188 |
Cost_CPT_99226 | Observation care facility setting—subsequent visit; 2015 Medicare national average payment | Dervied from Medicare PPS FY 2015 | $106 | 0 | 106 |
Cost_CPT_97001 | National average payment Medicare for physical therapy initial evaluation | Medicare PPS FY2015 | $75.44 | 0 | 75.44 |
Cost_CPT_97112 | National average payment rate for neuromuscular rehabilitation per day | Medicare PFS FY 2015 | $33.61 | 0 | 33.61 |
Average_LOS_IRF | Length of stay inpatient rehabilitation facility post complication resulting for neurosurgery in an eloquent area of the brain | Assumes and average LOS of 10 days—derived from Case Mix Group 301 for nontraumatic brain injury from surgery | 10 | 0 | 10 |
Cost_APC_0067 | CMS payment for APC 0067—cranial SRS | CMS FY 2015 payment rate for aPC 0067 @ $9765.40—for SRS brain | $9765.40 | 0 | 20,000 |
Cost_CPT_77372 | National average payment for Medicare for treatment of brain cancer using SRS linear accelerator | Medicare FY 2015 payment rate for SRS linear based | $1063 | 0 | 1063 |
OS_Survival_KPS_70_or_lower | Overall median survival in months with a Karnofsky Performance Score of less than or equal to 70 | Derived from Simpson JR et al. [51] | 7.8 | 0 | 7.8 |
OS_Survival_KPS_80_or_greater | Overall median survival in months with a Karnofsky Score of 80 or greater | Derived from Lacroix et al. [13] | 11.2 | 0 | 11.2 |
OS_survival_SRS | Median survival time in months for patients with SRS after failed surgery | Derived from Niranjan A, et al. [52] | 9.03 | 0 | 9.03 |
Cost_CPT_77262 | Therapeutic radiation treatment planning—intermediate | Radiation treatment planning for SRS (EBRT)—Medicare reimbursement for CY 2015 | $113 | 0 | 113 |
Cost_CPT_77285 | Therapeutic radiology simulation—intermediate | Cost for simulation treatment—therapeutic radiology—Medicare CY 2015 payment rate | $428 | 0 | 428 |
Cost_CPT_77306 | Cost EBRT isodose plans for radiation therapy | Cost for EBRT isodose planning—Medicare CY 2015 | $146 | 0 | 146 |
Cost_CPT_77300 | Cost for dosimetry calculations | Medicare reimbursement for dosimetry calculations—CY 2015 | $63 | 0 | 63 |
Cost_CPT_77333 | Cost for design and construction for treatment devices used to protect normal tissues | Medicare reimbursement CY 2015 for design and construction of treatment devices used to protect normal tissues | $53 | 0 | 53 |
Cost_CPT_77336 | Cost for medical physicists time in treatment and planning | Medicare reimbursement for medical physicist CY 2015 | $77 | 0 | 77 |
Cost_CPT_77370 | Cost medical physicist consultative report | Medicare payment for medical physicist consultative report | $117 | 0 | 117 |
Cost_CPT_77432 | Cost reporting patient’s care—review films, review dosimetry and chart | Medicare reimbursement for reporting patient’s care during EBRT—CY 2015 | $419 | 0 | 419 |
Cost_CPT_61517 | Medicare reimbursement for placement of carmustine wafer placement in patient with high grade glioma | Medicare national average reimbursement amount for placement of carmustine wafer placement in patient with a high grade glioma—2015 | $94 | 0 | 94 |
Cost_DRG_23 | National average reimbursement amount for DRG 23—craniotomy with major device implantation | National average payment amount for DRG 23—craniotomy with major device implantation—chemo implant (e.g. carmustine wafer. Based on level II evidence, carmustine wafers are recommended in patients for whom craniotomy is indicated. Fadul CE et al. [28] | $31,090 | 0 | 31,090 |
Costs_Planning_EBRT | Combined physician service costs for EBRT | Medicare 2015 reimbursement for planning and reporting on EBRT | Cost_CPT_77262 + Cost_CPT_77285 + Cost_CPT_77300 + Cost_CPT_77306 + Cost_CPT_77333 + Cost_CPT_77336 + Cost_CPT_77370 + Cost_CPT_77432 | 0 | 1416 |
Cost_TMZ_with_radiation | Cost TMZ oral therapy during period of radiation—total of 6 weeks | Cost of TMZ as per Medicare fee schedule J8700 = $9.75/pill. Obtained from 2013 Ingenix HCPCS level II code national average Medicare payment amount. Therefore $9.75 X 42 = $409.50 | $410 | 0 | 410 |
Cost_TMZ_per_pill | Cost of TMZ per pill—HCPCS code J8700 | Cost of TMZ per pill based on 2013 HCPCS level II code book for J8700 @ $9.75/pill | $9.75 | 0 | 9.75 |
Percent_Gliadel_wafer | Percent of time gliadel wafer used as adjuncitve therapy in high grade glioma post craniotomy | Derived from Price et al. [30] | Percent_Gliadel_wafer_implantations | 0 | 1 |
Percent_neuro_deficit_Gliadel | Percent of patients experiencing neurological deficit with Gliadel wafer | Derived from Bregy et al. [37] | 0.153 | 0 | 0 |
Percent_major_comps_surg_plus_Gliadel | Combination of major complications resulting from major surgery plus Gliadel usage | Percent_neuro_deficit_Gliadel + Percent_major_complications_surgery | 0 | 0 | |
Percent_biopsy_disch_SNF_IRF | Percent of patients with biopsy procedure discharged to SNF or IRF post biopsy | Derived from Malone et al. 2015 World Neursurg—24.4 % of all patients with a stereotactic biopsy discharged either to SNF or IRF | 0.244 | 0 | 0 |
Cost_SNF | Cost skilled nursing facility in caring for a patient post brain surgery | Derived from 2015 Medicare rates in caring for a person post brain surgery in a skilled nursing facility | $4930 | 0 | 0 |