OBJECTIVE: This study evaluates the efficiency and cost-effectiveness of an oncological outpatient neurosurgery protocol using enhanced recovery after surgery principles in a European healthcare setting. Additionally, it assesses the impact of incorporating hospital at home (HaH) for perioperative follow-up on program efficiency and costs. METHODS: We analyzed a case cohort of patients who underwent oncological outpatient neurosurgery with HaH-based postoperative follow-up for tumor removal or biopsy at a tertiary care center since 2019. A control cohort treated under standard inpatient care was also examined. Costs associated with surgery and postoperative care were meticulously calculated for both groups. RESULTS: The case (n = 17) and control (n = 38) cohorts had comparable demographics and clinical profiles. Surgical costs, including operating room, anesthesia, and surgeon fees, were similar across groups. However, postoperative monitoring was significantly shorter for the outpatient cohort, leading to reduced observation costs (P <
0.001). While the duration of follow-up care was similar, outpatient follow-up via HaH was more cost-effective, reducing overall surgery costs by approximately €2958 per patient (P <
0.001) compared to inpatient care. No significant differences were observed in costs related to treatment, radiology, or lab tests between groups. CONCLUSIONS: Outpatient neurosurgery with HaH follow-up offers substantial cost savings without compromising care quality in a public health setting. Inpatient care's higher costs are largely due to bed utilization, while the integration of HaH does not add significant costs, making it a viable alternative for postoperative management.