Clinical Scorecard: Long-term Follow-up of Healthcare Use and Expenses in Patients with Intracranial Meningiomas
At a Glance
Category
Detail
Condition
Intracranial meningiomas, primarily WHO grade I and II
Key Mechanisms
Benign tumors with near-normal life expectancy; symptoms include vision impairment, mental changes, seizures; long-term impairments in role functioning, neurocognitive deficits, anxiety, and depression
Target Population
Adults (≥18 years) with histologically confirmed WHO grade I or II meningioma or clinical diagnosis by MRI, at least five years post-primary treatment or diagnosis
Care Setting
Outpatient clinics in neurosurgery, neurology, radiation oncology at academic tertiary referral centers and large non-academic teaching hospitals
Key Highlights
Despite radiological cure, patients report significant long-term disease burden including physical, emotional, and cognitive impairments.
Long-term healthcare utilization includes visits to multiple specialists and use of medications such as antiepileptics, benzodiazepines, antidepressants, and hormone replacement therapy.
Healthcare costs encompass medical specialist care, mental healthcare, hospital admissions, emergency visits, and medication, calculated using Dutch reference prices.
Guideline-Based Recommendations
Diagnosis
Confirm diagnosis via histology for surgical cases or clinical MRI diagnosis for radiotherapy or surveillance cases.
Exclude patients with whole-brain radiotherapy history, neurofibromatosis type II, or neurodegenerative diseases.
Management
Primary antitumor treatment includes surgery or radiotherapy; active MRI surveillance is an option for some patients.
Monitor and address physical, emotional, and neurocognitive impairments even after radiological cure.
Monitoring & Follow-up
Use validated patient-reported outcome measures (PROMs) such as SF-36, EORTC QLQ-BN20, and HADS to assess quality of life, anxiety, and depression.
Assess healthcare utilization annually including specialist visits, medication use, emergency room visits, and hospital admissions.
Risks
Persistent impairments in role functioning, neurocognitive deficits, anxiety, and depression despite treatment.
Increased healthcare utilization and associated costs due to long-term disease burden.
Patient & Prescribing Data
Long-term meningioma survivors (≥5 years post-treatment or diagnosis) without recurrence
Use of antiepileptic drugs, benzodiazepines, antidepressants, and hormone replacement therapy is common; medication and healthcare utilization should be regularly reviewed.
Clinical Best Practices
Implement long-term follow-up care focusing on physical, emotional, and cognitive health beyond tumor control.
Utilize multidisciplinary teams including neurologists, neurosurgeons, oncologists, psychologists, and rehabilitation specialists.
Incorporate patient-reported outcome measures to guide individualized care and monitor disease burden.
Identify determinants of healthcare utilization to optimize resource allocation and improve patient outcomes.
by Kevin A. Huynh, Eva C. Coopmans, Amir H. Zamanipoor Najafabadi, Linda Dirven, Saskia M. Peerdeman, Nienke R. Biermasz, Marco J. T. Verstegen, Wouter R. van Furth
