Cost-effectiveness of the single-surgeon approach in microvascular decompression for trigeminal neuralgia

Background

Centralizing surgical cases to a dedicated surgeon (single-surgeon approach) has shown improved outcomes in various neurosurgical procedures, including microvascular decompression (MVD) for trigeminal neuralgia (TN). However, the cost-effectiveness of this approach in MVD for TN has not been conclusively demonstrated. This study aims to investigate the cost-effectiveness of the single-surgeon approach in MVD for TN compared to the conventional multi-surgeon approach.

Methods

A prospective cohort study was conducted from 2014 to 2020 (multi-surgeon approach 2014–2017; single-surgeon approach 2018–2020). Data on demographic and clinical characteristics, pain control, complications, hospital length of stay, and costs from the healthcare provider’s perspective (pre-operative, operative, post-operative, follow-up intervention, and complication-related) were documented. Pain-and-complication-specific quality-adjusted life years (PCQALY) were calculated using Kaplan-Meier favorable-pain-control and complication-free probability curves, followed by a cost-effectiveness analysis.

Results

Seventy-two patients were included (46 in the single-surgeon group, 26 in the multi-surgeon group). The single-surgeon approach yielded a higher 3-year PCQALY gain (2.8 vs. 1.6) and significantly shorter hospital stays (5.7 ± 3.5 days vs. 8.9 ± 3.9 days) despite higher total costs (USD 12,462 ± 5,577 vs. USD 9,128 ± 4,012) (p < 0.05). The single-surgeon approach had a cost-effectiveness ratio of USD 4,491/PCQALY (vs. USD 5,635/PCQALY for the multi-surgeon approach), with an Incremental Cost-Effectiveness Ratio (ICER) of USD 2,887/PCQALY gained (0.65 times GDP/capita), indicating its cost-effectiveness according to World Health Organization criteria.

Conclusion

The single-surgeon approach is cost-effective despite its higher associated costs, due to its superior pain control and complication profile.