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Costs Associated With Surgical Treatment Delay In Patients With Occipital Neuralgia: A Prospective Cohort Study.
Merel Hazewinkel, MD1, Katya Remy, MD2, Grant Black, MD1, Sierra Tseng, student2, Paul G. Mathew, MD3, Anna Schoenbrunner, MD4, Jeffrey E. Janis, MD4, William G. Austen, MD2, Rohan Jotwani, MD1, Lisa Gfrerer, MD1;
1Weill Cornell Medicine, New York, NY, USA, 2Massachusetts General Hospital, Boston, MA, USA, 3Mass General Brigham Health, Foxborough, MA, USA, 4The Ohio State University Wexner Medical Center, Columbus, OH, USA

Background. Nerve decompression surgery is not considered as part of the occipital neuralgia therapeutic algorithm The aim of this study was to evaluate the time between onset of occipital neuralgia symptoms and nerve decompression surgery and perform a cost comparison analysis between surgical and non-surgical treatment of occipital neuralgia.Methods. 1,112 subjects who underwent screening for nerve decompression surgery were screened for a diagnosis of occipital neuralgia. 367 (33%) patients met the inclusion criteria. Timing of occipital neuralgia symptom onset and pain characteristics were prospectively collected. Direct and indirect costs associated with the non-surgical treatment of occipital neuralgia was calculated for the period between onset of symptoms and surgery.Results. 226 (73%) patients underwent occipital nerve decompression. The average time between onset of occipital neuralgia and surgery was 19 years (7.1-32). The annual mean direct cost of non-surgical ON treatment was $14,209.88 ($4,994.70-$23,425.06) per patient. The annual mean indirect cost of non-surgical treatment was $35,397.99 ($27,623.76-$43,332.39).The annual mean cost of non-surgical occipital neuralgia treatment resulted in $49,607.87 ($32,618.46- $66,757.45) per patient. In comparison the mean cost of nerve decompression surgery was $12,000.00.Conclusion. This study demonstrates that patients suffer from occipital neuralgia for an average of 19 years prior to undergoing nerve decompression surgery. Nerve decompression surgery should be considered earlier in the treatment course of occipital neuralgia that is refractory to conservative treatment to prevent patient morbidity and decrease direct and indirect healthcare costs.
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