The Surgical Management of Trigeminal Neuralgia: Do We Practice What We Preach? Cost-Effectiveness Determined Using the Medicare Claims Database

Object: To use Medicare claims data in conjunction with a literature review to asses 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. 6% of patients underwent surgical intervention. 51.1% of surgical patients underwent MVD, 41.5% underwent SRS and 7.4% underwent PSR. The average weighted cost for MVD, SRS and PSR were $40,434.95, $38,062.27 and $3910.64 respectively. The 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 effective surgical management of Trigeminal Neuralgia is MVD and the most cost effective is PSR. SRS, although heavily favored in practice, appears to have a lower QALY and a higher cost per QALY.

	N	%	Male	Female	Average Weighted Charge ($)
MVD	48	51.1	20 (41.7)	28 (58.3)	40434.95
SRS	39	41.5	12 (30.8)	27 (69.2)	38062.27
PSR	7	7.4	2 (28.6)	5 (71.4)	3910.64

Procedure	N	QALY	Cost/QALY
MVD	48	8.2	4931.1
SRS	39	4.9	7767.8
PSR	7	6.5	601.64