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Neurosurgery:
doi: 10.1227/NEU.0000000000000430
RESEARCH - HUMAN - CLINICAL STUDIES: PDF Only

Surgical Management of Trigeminal Neuralgia: Use and Cost Effectiveness From an Analysis of the Medicare Claims Database.

Sivakanthan, Sananthan BS; Van Gompel, Jamie J. MD; Alikhani, Puya MD; van Loveren, Harry MD; Chen, Ren PhD MPH; Agazzi, Siviero MD MBA

Published Ahead-of-Print
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Abstract

Background: Trigeminal neuralgia is a relatively common neurosurgical pathology with multiple management options. Microvascular decompression (MVD) is non-ablative and is considered the gold standard. However, stereotaxic radiosurgery (SRS) and percutaneous stereotaxic rhizotomy (PSR) are two non-invasive but ablative options that have rapidly gained support.

Objective: To use Medicare claims data in conjunction with a literature review to assess the usage, effectiveness, and cost-effectiveness of the three different invasive treatments for trigeminal neuralgia.

Methods: All of the claims of trigeminal neuralgia treatment were extracted from the 2011 5% Inpatient and Outpatient Limited Data Set. CPT-4/ICD-9 codes for the three different surgical treatment modalities were used to further classify these claims. Kaplan-Meier survival curves in key papers were used to calculate Quality Adjusted Life Years and cost-effectiveness for each procedure.

Results: 1582 claims of trigeminal neuralgia were collected. 94 (6%) patients underwent surgical intervention. 48 (51.1%) surgical patients underwent MVD, 39 (41.5%) underwent SRS and 7 (7.4%) underwent PSR. The average weighted cost for MVD, SRS, and PSR were $40,434.95, $38,062.27, and $3,910.64, respectively. The quality adjusted life years (QALY) for MVD was 8.2, 4.9 for SRS, and 6.5 for PSR. The Cost per QALY was calculated as $4,931.1, $7,767.8, and $601.64 for MVD, SRS, and PSR, respectively.

Conclusion: This study shows that the most frequently used surgical management of trigeminal neuralgia is MVD, followed closely by SRS. PSR, despite being the most cost-effective, is by far the least utilized treatment modality.

Copyright (C) by the Congress of Neurological Surgeons

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