More common procedures for painful facial tics carry high costs, reports study in Neurosurgery

Surgery for trigeminal neuralgia -- most cost-effective treatment is least used

2014-08-22

(Press-News.org) August 22, 2014 – For patients who need surgery for facial pain caused by trigeminal neuralgia, the most cost-effective procedure is the least often used, reports a study in the September issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Percutaneous stereotaxic rhizotomy (PSR) provides good pain relief at much lower cost than other types of surgical treatments for trigeminal neuralgia, according to the report by Dr. Siviero Agazzi and colleagues of University of South Florida, Tampa. The researchers write, "PSR, despite being the most cost-effective, is by far the least utilized treatment modality."

Surgical Options for Trigeminal Neuralgia… Trigeminal neuralgia is a relatively common chronic pain condition, especially among older adults. Sometimes called "tic douloureux," trigeminal neuralgia is associated with a typical pattern of painful facial tics. Pain is thought to be caused by blood vessels placing pressure on the trigeminal nerve in the face.

When pain from trigeminal neuralgia can't be adequately controlled by medications, various surgical procedures may be recommended. To compare the cost-effectiveness of different surgical options, the researchers analyzed data on Medicare claims for trigeminal neuralgia during 2011. Of 1,582 patients with trigeminal neuralgia, 94 patients—six percent of the total—underwent surgical treatment.

Fifty-one percent of surgically treated patients underwent a procedure called microvascular decompression (MVD), in which a pad is placed to relieve pressure on the nerve. Forty-two percent underwent stereotactic radiosurgery (SRS), a less-invasive "gamma knife" procedure. The remaining seven percent of patients underwent PSR—a percutaneous operation in which the nerve fibers causing pain are destroyed by a needle inserted from the cheek all the way into the skull.

But although PSR was the least commonly used procedures, it was the least expensive, with an average weighted cost of about $3,900. That was about one-tenth the cost of the other two options: about $40,000 for MVD and $38,000 for SRS.

…Show Wide Variations in Cost-Effectiveness Based on published data, all three procedures reduced pain from trigeminal neuralgia, with some differences in effectiveness. Over ten years, average "quality-adjusted life-years" (QALYs)—reflecting one year free of pain and without pain medications—were 8.2 for MVD, 4.9 for SRS, and 6.5 for PSR.

After accounting for these differences, PSR was by far the most cost-effective option. Cost per QALY gained was about $600 with PSR, compared to $4,900 for MVD and $7,800 for SRS. Percutaneous stereotaxic rhizotomy was eight times more cost-effective than MVD and 13 times more cost-effective than SRS.

Dr. Agazzi and coauthors emphasize that their Medicare claims study is only preliminary. It was based on small numbers of patients—including just seven treated with PSR. It also included limited data on outcomes and complications, such as facial numbness. But within those limitations, the results suggest that PSR is an "under-utilized" procedure for patients with painful facial tics. The PSR procedure provides comparable pain relief, at a fraction of the cost of more commonly performed procedures. While further research is needed, Dr. Agazzi and colleagues note their findings are consistent with the only two previous studies evaluating the cost-effectiveness of surgical options for trigeminal neuralgia.

INFORMATION: Click here to read "Surgical Management of Trigeminal Neuralgia: Use and Cost-Effectiveness From an Analysis of the Medicare Claims Database"

About Neurosurgery Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Wolters Kluwer Health Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries worldwide, clinicians rely on Wolters Kluwer Health's market leading information-enabled tools and software solutions throughout their professional careers from training to research to practice. Major brands include Health Language®, Lexicomp®, Lippincott Williams & Wilkins, Medicom®, Medknow, Ovid®, Pharmacy OneSource®, ProVation® Medical and UpToDate®.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2013 annual revenues of €3.6 billion ($4.7 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America.maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Alphen aan den Rijn, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).

Follow our official Twitter handle: @WKHealth.

ELSE PRESS RELEASES FROM THIS DATE:

Hormone analysis helps identify horny rhinos

2014-08-22

The first comprehensive study of captive black rhino reproduction in Europe highlights how hormone analysis could improve the success of breeding programmes. Researchers from Chester Zoo, The University of Manchester and the University of Liverpool carried out a six-year study which encompassed 90% of European population of black rhino. Dr Katie Edwards led the research as part of her PhD at the University of Liverpool. She says: "Although some black rhinoceros breed well in captivity, not all do therefore reducing the vital genetic reserve that these populations represent. ...

Poll finds many in US lack knowledge about Ebola and its transmission

2014-08-22

Boston, MA – Although the Centers for Disease and Prevention (CDC) reports no known cases of Ebola transmission in the United States, a Harvard School of Public Health (HSPH)/SSRS poll released today (August 21, 2014) shows that four in ten (39%) adults in the U.S. are concerned that there will be a large outbreak in the U.S., and a quarter (26%) are concerned that they or someone in their immediate family may get sick with Ebola over the next year. The nationally representative poll of 1,025 adults was conducted August 13-17, 2014 by researchers at HSPH and SSRS, an ...

In our digital world, are young people losing the ability to read emotions?

2014-08-22

Children's social skills may be declining as they have less time for face-to-face interaction due to their increased use of digital media, according to a UCLA psychology study. UCLA scientists found that sixth-graders who went five days without even glancing at a smartphone, television or other digital screen did substantially better at reading human emotions than sixth-graders from the same school who continued to spend hours each day looking at their electronic devices. "Many people are looking at the benefits of digital media in education, and not many are looking ...

Green tea polyphenols protect spinal cord neurons against oxidative stress

2014-08-22

Green tea polyphenols are strong antioxidants and can reduce free radical damage. Can they protect spinal cord neurons against oxidative stress? Jianbo Zhao and co-workers from the First Affiliated Hospital of Liaoning Medical University, China discovered that green tea polyphenol effectively alleviated oxidative stress and inhibit neuronal apoptosis, indicating green tea polyphenols play a protective role in spinal cord neurons under oxidative stress. The relevant study has been published in the Neural Regeneration Research (Vol. 9, No. 14, 2014). INFORMATION: Article: ...

Recombinant adenovirus-mediated DHCR24 inhibits neural apoptosis

2014-08-22

3β-Hydroxysteroid-Δ24 reductase (DHCR24) is a multifunctional enzyme that localizes to the endoplasmic reticulum and has neuroprotective and cholesterol-synthesizing activities. DHCR24 overexpression confers neuroprotection against apoptosis caused by amyloid β deposition. Dr. Xiuli Lu and colleagues from Liaoning University in China constructed two recombinant adenoviruses (Ad-rSYN1-DHCR24-myc and Ad-hSYN1-DHCR24-myc) that drive DHCR24 expression specifically in neuronal cells. They also found that adenovirus transfection inhibits apoptosis through scavenging ...

Smokers consume same amount of cigarettes regardless of nicotine levels

2014-08-22

Cigarettes with very low levels of nicotine may reduce addiction without increasing exposure to toxic chemicals, according to a new study from the University of Waterloo. The study published in the journal Cancer Epidemiology monitored the smoking behaviours of 72 adults as they switched to three types of cigarettes with markedly reduced nicotine levels. Unlike when smokers switch between conventional cigarette brands—all of which have very similar levels of nicotine content—the study found no change in participants' puffing behaviour, number of cigarettes consumed ...

Spectacular supernova's mysteries revealed

2014-08-22

New research by a team of UK and European-based astronomers is helping to solve the mystery of what caused a spectacular supernova in a galaxy 11 million light years away, seen earlier this year. The supernova, a giant explosion of a star and the closest one to the Earth in decades, was discovered earlier this year by chance at the University of London Observatory. These phenomena are extremely important to study because they provide key information about our universe, including how it is expanding and how galaxies evolve. The new research into its cause, published ...

Citizen scientists saving lives around deadly 'Throat of Fire' volcano

2014-08-22

Citizen scientists are saving the lives of people living in the shadow of deadly volcanoes according to new research from the University of East Anglia. A new report published today reveals the success of a volunteer group set up to safeguard communities around the 'Throat of Fire' Tungurahua volcano in the Ecuadorian Andes. More than 600 million people live close to active volcanoes worldwide. The research shows that living safely in these dangerous areas can depend on effective communication and collaboration between volcanologists, risk managers and vulnerable communities. It ...

Stanford scientists develop a water splitter that runs on an ordinary AAA battery

2014-08-22

In 2015, American consumers will finally be able to purchase fuel cell cars from Toyota and other manufacturers. Although touted as zero-emissions vehicles, most of the cars will run on hydrogen made from natural gas, a fossil fuel that contributes to global warming. Now scientists at Stanford University have developed a low-cost, emissions-free device that uses an ordinary AAA battery to produce hydrogen by water electrolysis. The battery sends an electric current through two electrodes that split liquid water into hydrogen and oxygen gas. Unlike other water splitters ...

Genetics and lifestyle have a strong impact on biomarkers for inflammation and cancer

2014-08-22

In a new study published in Nature Communications, research scientists from Uppsala University present for the first time a large-scale study of the significance of genetic, clinical and lifestyle factors for protein levels in the bloodstream. The results of the study show that genetics and lifestyle are determining factors for protein levels, a discovery which greatly influences the possibilities for using more biomarkers to identify disease. Biomarkers used for diagnosing disease should preferably indicate variations in protein levels only for those individuals who ...

LAST 30 PRESS RELEASES:

Global cervical cancer vaccine roll-out shows it to be very effective in reducing cervical cancer and other HPV-related disease, but huge variations between countries in coverage

Personalised “cocktails” of antibiotics, probiotics and prebiotics hold great promise in treating a common form of irritable bowel syndrome, pilot study finds