167 The Cost Effectiveness of Surgery For Trigeminal Neuralgia in Surgically Naive Patients, A Retrospective Study

Abstract

INTRODUCTION: For 75% of patients with trigeminal neuralgia (TN), the pain can be controlled with medications. For those who fail medication therapy, surgical options include microvascular decompression (MVD), percutaneous radiofrequency rhizotomy (PRFR), and stereotactic radiosurgery (SRS). Few studies have explored cost effectiveness, particularly in surgically naive patients. METHODS: A retrospective chart review performed between 01/2003 and 01/2013 identified a total of 81 patients who underwent surgical treatment for TN (MVD = 39; PRFR = 16; SRS = 26). Outcome measures included facial pain [excellent (no pain, no medications), good (no pain, medications required), fair (>50% decrease in pain), and poor (<50% decrease in pain/secondary surgery)], numbness, and cost. RESULTS: Average ages of patients were MVD = 53.7 ± 14 (14-83), PRFR = 75.4 ± 13 (38-92), and SRS = 73.4 ± 13 (41-86). Mean quality adjusted pain-free years were MVD = 1.58, PRFR = 2.28, and SRS = 0.99. Total fees for the procedures (US dollars) were MVD = 50 100 ± 9600, PRFR = 4800 ± 2200, and SRS = 39,300 ± 6000. Actual collections varied by insurance. Percent of postoperative facial numbness was MVD = 13%, PRFR = 75%, and SRS = 12%. Rates of recurrence requiring a second procedure were MVD = 10%, PRFR = 57%, and SRS = 16%. Cost Effectiveness calculations showed MVD = 32,000, PRFR = 2000, and SRS = 40,000. CONCLUSION: There are significant cost differences among the common surgical procedures for TN. MVD was the most expensive procedure, more likely to be performed on younger patients, and had the lowest rate of facial numbness as well as recurrence requiring a secondary procedure. SRS was slightly less costly, more likely to be performed on an older population, and had a similar rate of facial numbness and recurrence. PRFR was the least expensive procedure, provided immediate relief, but was associated with the highest rates of facial numbness and recurrence. Based on cost-effectiveness, considering both cost and outcome, PRFR was the most cost-effective followed by MVD and finally SRS.