Table 27:
Resource Item | MRgFUS Neurosurgery, $ | Deep Brain Stimulation, $ | Radiofrequency Thalamotomy, $ | Data Source and Comments |
---|---|---|---|---|
Pre-procedure | ||||
Neurology consultation | 176 | 176 | 176 | Schedule of Benefits (A185)91 |
Neurosurgery consultation | 121 | 121 | 121 | Schedule of Benefits (A045)91 |
MRI scan | ||||
Professional fee | 73 | 73 | 73 | Schedule of Benefits (X421)91 |
Procedure cost | 972 | 972 | 972 | OCC 2015 (CCI code 3.AN.40), ambulatory92 |
CT scan | ||||
Professional fee | 65 | NA | NA | Schedule of Benefits (X401)91 |
Procedure cost | 513 | NA | NA | OCC 2015 (CCI code 3.AN.20), ambulatory92 |
Total pre-procedure costs | 1,921 | 1,343 | 1,343 | |
Peri-procedure | ||||
Inpatient procedure cost | 14,095a | 17,221b | 6,822c | MRgFUS thalamotomy (clinical expert, email communication, June 21, 2017); deep brain stimulation (OCC 201592); radiofrequency thalamotomy (OCC 201692) |
Device cost | NA | 14,355 | NA | Medtronic 2011; 90% unilateral DBS based on expert opinion (email communication, July 13, 2017) |
Physician fees | 1,551 | 1,551 | 1,551 | Schedule of Benefits (N124)91 |
Surgical assistant | 445 | 590 | 373 | Schedule of Benefits (N124)91 (see Appendix 6, Table A8) |
Anesthesiologist | 585 | 766 | 495 | Schedule of Benefits (N124)91 (see Appendix 6, Table A9) |
Total peri-procedure costs | 16,677 | 34,483 | 9,242 | |
Post-procedure | ||||
MRI scan | ||||
Professional fee | 73 | 73 | 73 | Schedule of Benefits (X421)91 |
Procedure cost | 972 | 972 | 972 | OCC 2015 (CCI code 3.AN.40.), ambulatory92 |
Neurology, repeat consultation | 85 | 85 | 85 | Schedule of Benefits (A186)91 |
Neurosurgeon, repeat consultation | 58 | 58 | 58 | Schedule of Benefits (A046)91 |
Initial DBS programming | NA | 363 | NA | Schedule of Benefits (G547, G549)91; 1.8 visits for initial programming based on Ondo et al, 2005,97 and Picillo et al, 201698 |
Total post-procedure costs | 1,189 | 1,551 | 1,189 | |
Total cost per procedure | 19,786 | 37,377 | 11,774 |
Abbreviations: CCI, Canadian Classification of Health Interventions; CT, computerized tomography; MRgFUS, magnetic resonance-guided focused ultrasound; MRI, magnetic resonance imaging; NA, not applicable; OCC, Ontario Case Costing database.
Note: All costs are presented in 2017 Canadian dollars.
This is the operational cost only; capital costs (i.e., those related to equipment, installation, and maintenance) are excluded in the reference case analysis.
CCI procedure code 1AE53SEJA (implantation, thalamus and basal ganglia, of electrodes [e.g., recording, stimulating] using burr hole approach) for essential tremor (G250); inflated from 2015 to 2017.
CCI procedure code 1AE59SEAW (destruction, thalamus and basal ganglia, using burr hole approach and radiofrequency probe) for all diagnoses; inflated from 2016 to 2017.