Cost-effectiveness of sural nerve biopsies – a single center experience

Introduction: Sural nerve biopsies are an accepted procedure for the analysis of neurological disorders of unknown origin. Given its rather superficial accessibility, the mere sensory function without any motor function and the predicted sensory loss the sural nerve is the most common nerve type for biopsies. However, to date the cost-effectiveness of sural nerve biopsies for diagnosis or treatment decisions is unknown.

Methods: 80 patients were enrolled in this cohort study based on the indication for sural nerve biopsy stated by neurologists. Laboratory test were performed according to the guidelines of the German Association of Neurology. Lumbar puncture and electrophysiological investigations including motor and sensory nerve conduction studies were routinely performed in all patients. The sural nerve biopsy underwent a standardized neuropathological examination program. According to the laboratory test and sural nerve biopsy results, diagnoses were classified into inflammatory neuropathies, acquired PNP, hereditary neuropathies and PNP of unknown aetiology. The costs for different tests and investigations were calculated.

Results: When performed by plastic surgeons, sural nerve biopsies are associated with a low complication rate of 4% within six weeks postoperatively. Diagnostic consequences arouse in 36%, therapeutic consequences in 23% based on the result of sural nerve biopsies. Guideline-based laboratory routine workup, lumbar puncture and electrophysiology account for about 420€, surgery costs for about 200€ and neuropathology workup for about 250€.

Conclusions: Given the limited financial resources as well as the potential complication rate in terms of sensory loss and potential wound complications, rigours indications for sural nerve biopsy should be considered.