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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*

doi: 10.1227/NEU.0000000000000430
Research-Human-Clinical Studies: Editor's Choice
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BACKGROUND: Trigeminal neuralgia is a relatively common neurosurgical pathology with multiple management options. Microvascular decompression (MVD) is nonablative and is considered the gold standard. However, stereotaxic radiosurgery (SRS) and percutaneous stereotaxic rhizotomy (PSR) are 2 noninvasive 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 3 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. Current Procedural Terminology, 4th Edition/International Classification of Diseases, Ninth Revision codes for the 3 different surgical treatment modalities were used to further classify these claims. Kaplan-Meier survival curves in key articles were used to calculate quality-adjusted life years and cost-effectiveness for each procedure.

RESULTS: A total of 1582 claims of trigeminal neuralgia were collected. Ninety-four (6%) patients underwent surgical intervention. Forty-eight (51.1%) surgical patients underwent MVD, 39 (41.5%) underwent SRS, and 7 (7.4%) underwent PSR. The average weighted costs for MVD, SRS, and PSR were $40 434.95, $38 062.27, and $3910.64, respectively. The quality-adjusted life years were 8.2 for MVD, 4.9 for SRS, and 6.5 for PSR. The cost per quality-adjusted life year was calculated as $4931.1, $7767.8, 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.

ABBREVIATIONS: BNI, Barrow Neurological Institute

ICD-9, International Classification of Diseases, Ninth Revision

MVD, microvascular decompression

PSR, percutaneous stereotaxic rhizotomy

QALY, quality-adjusted life year

SRS, stereotaxic radiosurgery

TN, trigeminal neuralgia

*Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida;

Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;

§Department of Epidemiology and Biostatistics, University of South Florida, Tampa, Florida

Correspondence: Siviero Agazzi, MD, MBA, Department of Neurosurgery and Brain Repair, USF Health South Tampa Center, 2 Tampa General Circle, Tampa, FL 33606. E-mail:

Received October 10, 2013

Accepted April 21, 2014

Copyright © by the Congress of Neurological Surgeons