Fast pace growth in technological innovation is becoming one of the principal factor determining healthcare expenditures and costs escalation in health care systems. In radiotherapy, the new technological frontier is represented by stereotactic cyber knife radiosurgery (CKR) that has been proven to be an effective treatment for trigeminal neuralgia (TN) or “tic douloureux”. The objective of this paper is to compare the cost-effectiveness of CKR and microvascular decompression surgery (MVD) for patients with medically unresponsive TN. A cost-effectiveness study was conducted. The analysis was observational and incidence based, the perspective adopted was that of the hospital. Direct healthcare costs and clinical outcome attributable to CKR vs. MVD in managing TN patients were measured and confronted. Pain-before and -after for both MVD and CKR procedures was measured through the Barrow Neurological Institute (BNI) pain intensity scoring criteria. Patients with CKR were prospectively enrolled at Centro Diagnostico Italiano while patients with MVD were retrospectively recruited at the “C. Besta” National Neurological Institute. One way sensitivity analysis was performed for costing data. A total of 40 patients were enrolled in the study, 20 for both arms. The two procedures resulted equally effective at 6 month follow-up, but with different costs: Euro 6,641.0 and Euro 4,388.5 for MVD and CKR respectively..CKR therefore reduces hospital costs by 34% per patient. Technological innovation is one of the main determinants of healthcare costs and its rapid changes require decision makers to take allocative decisions in relatively short time. Even though the present results are preliminary, and need to be further verified as long as the technology develops, they can already inform current and future decisions as to whether and how much of the technology is needed and who are the patients that can benefit the most from it.
Cost-effectiveness for trigeminal neuralgia: Cyberknife vs microvascular decompression
TARRICONE, ROSANNA;
2008
Abstract
Fast pace growth in technological innovation is becoming one of the principal factor determining healthcare expenditures and costs escalation in health care systems. In radiotherapy, the new technological frontier is represented by stereotactic cyber knife radiosurgery (CKR) that has been proven to be an effective treatment for trigeminal neuralgia (TN) or “tic douloureux”. The objective of this paper is to compare the cost-effectiveness of CKR and microvascular decompression surgery (MVD) for patients with medically unresponsive TN. A cost-effectiveness study was conducted. The analysis was observational and incidence based, the perspective adopted was that of the hospital. Direct healthcare costs and clinical outcome attributable to CKR vs. MVD in managing TN patients were measured and confronted. Pain-before and -after for both MVD and CKR procedures was measured through the Barrow Neurological Institute (BNI) pain intensity scoring criteria. Patients with CKR were prospectively enrolled at Centro Diagnostico Italiano while patients with MVD were retrospectively recruited at the “C. Besta” National Neurological Institute. One way sensitivity analysis was performed for costing data. A total of 40 patients were enrolled in the study, 20 for both arms. The two procedures resulted equally effective at 6 month follow-up, but with different costs: Euro 6,641.0 and Euro 4,388.5 for MVD and CKR respectively..CKR therefore reduces hospital costs by 34% per patient. Technological innovation is one of the main determinants of healthcare costs and its rapid changes require decision makers to take allocative decisions in relatively short time. Even though the present results are preliminary, and need to be further verified as long as the technology develops, they can already inform current and future decisions as to whether and how much of the technology is needed and who are the patients that can benefit the most from it.
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