title: Surgical management of trigeminal neuralgia: use and cost-effectiveness from an analysis of the Medicare Claims Database.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: *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.
authors.forename: Sananthan
authors.initials: S
authors.lastname: Sivakanthan
authors.forename: Jamie J
authors.initials: JJ
authors.lastname: Van Gompel
authors.forename: Puya
authors.initials: P
authors.lastname: Alikhani
authors.forename: Harry
authors.initials: H
authors.lastname: van Loveren
authors.forename: Ren
authors.initials: R
authors.lastname: Chen
authors.forename: Siviero
authors.initials: S
authors.lastname: Agazzi
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare; D061145:Microvascular Decompression Surgery / Q000191:economics; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics* / Q000379:methods*; D019057:Quality-Adjusted Life Years; D016634:Radiosurgery / Q000191:economics; D012189:Retrospective Studies; D019051:Rhizotomy / Q000191:economics / Q000379:methods; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000191:economics / Q000601:surgery*; D014481:United States