Cost-effectiveness analysis for trigeminal neuralgia: Cyberknife vs microvascular decompression

Figures & data

Table 1 Barrow Neurological Institute (BNI) Pain Intensity Scoring Criteria

Score	Description
I	No trigeminal pain
II	Occasional pain, not requiring medication
III	Some pain, adequately controlled with medication
IV	Some pain, not adequately controlled with medication
V	Severe pain/no pain relief

Table 2 Sample size and characteristics

Procedure	CKR (N = 20)		MVD (N = 20)
Age (at the time of the treatment)	Years		Years
Mean (SD)	74.2 (12.8)		61.9 (9.7)
Range	(40–88)		(41–75)
Gender	N.	%	N.	%
Female	12	60%	11	55%
Male	8	40%	9	45%
Previous TN treatment	N.	%	N.	%
Yes	8	40%	6	30%
No	12	60%	14	70%
Type of previous TN treatment	N.	%	N.	%
MVD	3	38%	4	67%
Thermal rhizothomy	5	63%	1	17%
Radiosurgery	–	–	1	17%
BNI Score at Baseline	N.	%	N.	%
IV. Some pain, not adequately controlled with medication	3	15%	15	75%
V. Severe pain/no pain relief	17	85%	5	25%

Table 3 Clinical outcome at follow-up – BNI Scale

BNI score at baseline	CKR (N = 20)		MVD (N = 20)
	N.	%	N.	%
IV. Some pain, not adequately controlled with medication	3	15%	15	75%
V. Severe pain/no pain relief	17	85%	5	25%
P-value (Chi-square test)	0,0001
BNI Score at FU	CKR (N = 20)		MVD (N = 20)
	N.	%	N.	%
I. No trigeminal pain	6	30%	9	45%
II. Occasional pain, not requiring medication	4	20%	7	35%
III. Some pain, adequately controlled with medication	8	40%	2	10%
IV. Some pain, not adequately controlled with medication	2	10%	2	10%
V. Severe pain/no pain relief	–	0%	–	0%
P-value (Chi-square test)	0,17

Table 4 Average direct healthcare cost per patient

Full Cost	CKR		MVD		DELTA
Cost category	Euro	%	Euro	%	Euro	%
Outpatient visits	47.4	1%	17.6	0%	−29.8	−1%
Imaging tests	437.2	10%	157.9	2%	−279.3	−12%
Radiation/Surgical procedure	3,903.9	89%	4,317.0	65%	413.1	18%
Drugs (related to procedure/TN)	–	0%	118.6	2%	118.6	5%
Laboratory tests	–	0%	73.3	1%	73.3	3%
Hospital stay costs	–	0%	1,956.7	29%	1,956.7	87%
Total	4,388.5	100%	6,641.0	100%	2,252.5	100%

Table 5 Threshold analysis

Variables	% Variation	Absolute variation	Treatment full cost	Preferred strategy
			MVD
Operating theatre utilization for MVD patients (hours)	−71%	Form 3.5 to 1 hour	Euro 4.388,5	Equal
LOS for MVD patients (days)	−100%	From 10.0 to 0.0 days	Euro 4.684,3	Dominated
			CKR
CKR annual activity (treated patients)	−46%	From 289 to 155 patients	Euro 6.641,0	Equal
Incidence of overheads in CKR Center (considered as a proxy of efficiency)	+2.6%	From 15.4 to 18 percentage points	Euro 4,483.21	Cost Saving