Analysis of the direct costs of patients undergoing neurosurgery for the treatment of primary brain neoplasms Thesis by Aline Lariessy Campos Paiva. Advisor: José Carlos Esteves Veiga

Objective: In developing countries there is a relative scarcity of data on costs in neurosurgery. These data are relevant to public health in order to guide allocation better resources and help with international cooperation, in particular clinical trials multicentric. This study aims to estimate the direct costs of adult patients a neurooncology during hospital stay in a large quaternary center in Brazil, the largest philanthropic hospital in Latin America. Methods: This observational economic analysis describes direct patient costs oncology treated by the Discipline of Neurosurgery of the Irmandade da Santa Casa de Mercy of São Paulo. In this analysis, only adult patients with one of the most Common types of primary brain neoplasms – meningioma or gliomas – were analyzed. All data from this cohort have been described. Results: During the study period from January 2008 to December 2019, the total number of 1279 medical records were analyzed. Fifty-three, point, thirty-seven percent (53.37%) were female patients. Most showed limits of age variation between 56 and 65 years old (22.5%). In addition, a sample with statistical significance (p< 0.05) of patients with gliomas and meningiomas operated after 2016 was analyzed (139 cases). the average cost estimated neurosurgical hospitalization was R$ 22,372.00 (U$ 4,166). Operating room costs and of the ICU represented the largest proportion within the total cost (29.24% and 24.05%, respectively). Meningiomas had the highest cost, but without statistical significance (p = 0.246). The duration of occupancy in the operating room was an average of 489 minutes. seventeen and half a percent (17.5%) of patients had some type of infection. The latter, most (66.7%) occurred in urgent procedures. The mortality rate was 12.7% and it is worth it is worth noting that 92.3% of deaths occurred in urgent procedures. Conclusions: This study evaluates the costs of cancer patients operated by the Discipline of Neurosurgery in a developing country. The time interval of room occupancy surgery was the most costly variable, followed by the period of hospitalization in a ICU. Surgeries performed on an urgent basis were the most associated with infections and mortality. These findings can be used to guide resource allocation, carry out economic analysis and establish the value of neurosurgery in terms of global health.