American Association of Plastic Surgeons

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Cost-Utility Analysis of Surgical Decompression Relative to Injection Therapy in Chronic Migraine Patients
Orr Shauly, BS1, Daniel J. Gould, MD, PhD2, Ketan M. Patel, MD2.
1Keck School of Medicine of USC, Los Angeles, CA, USA, 2Keck Hospital of USC, Los Angeles, CA, USA.

Purpose - Common treatment for chronic migraine headaches include injection of corticosteroid and anesthetic agents at local trigger sites. However, the effects of therapy are short-term and lifelong treatment is necessary. The purpose of this study was to assess alternative surgical approaches in the treatment of chronic migraines.
Methods - A cost-utility analysis was performed in consideration of costs, probabilities, and health state utility scores of the opposing interventions. Amazon Mechanical Turkę crowd-sourcing was used to derive utility scores associated with surgical decompression and injection therapy. A systematic review was also performed to identify common complications of treatment and their associated probabilities. Direct costs were derived from national Medicare facility reimbursement data and outpatient care billing data for fiscal year 2017, and indirect costs were accounted for by our utility estimates.
Results - Injection therapy offered a minor incremental benefit in quality-adjusted life-years greater than surgical decompression (QALY Δ = 0.6). However, long-term injection therapy was significantly costlier to society than surgical decompression, with treatment estimated at $106,887.96 greater than the cost of surgery. The results of our cost-utility analysis thus conferred a positive ICUR of $178,163.27 in favor of surgical decompression.
Conclusions - Surgery provides a durable intervention and has been shown in this study to be extremely cost-effective despite a very minor QALY deficit in comparison to injection therapy. If patients are identified that require treatment in the form of injections for less than 8.25 years, they may fall into a group that should not be offered surgery.


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