Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium.
Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium.
J Craniomaxillofac Surg. 2022 Aug;50(8):627-636. doi: 10.1016/j.jcms.2022.07.002. Epub 2022 Jul 8.
The present aim was to estimate direct health care costs of patients suffering from post-traumatic trigeminal neuropathy (PTTN) and to compare the use of health care services, medications, and costs between temporary and persistent (>3 months) PTTN cohorts. A pre-existing clinical dataset of PTTN patients visiting a tertiary orofacial pain clinic in Belgium was utilized, including symptoms and quality of life measurements. Cost and resource utilization data were obtained by Belgium's largest health insurance provider for a period of 5 years after onset. Data from 158 patients was analyzed. The average cost per patient in the first year after injury was €2353 (IQR 1426-4499) with an out-of-pocket expense of 25% of the total cost. Hospitalization and technical interventions were the main drivers of cumulative costs, followed by consultation costs. For each cost category, expenditure was significantly higher in patients with persistent PTTN than in those with temporary PTTN (median 5-year total costs in persistent PTTN patients yielded €8866 (IQR 4368-18191) versus €4432 (IQR 2156-9032) in temporary PTTN, p <0.001) PTTN patients received repeated and frequent head and neck imaging (mean number of imaging investigations per patient was 10 ± 12). Medication consumption was high, with an unwarranted higher use of opioids and antibiotics in persistent PTTN patients. Within the limitations of this study, it seems there is a need for informing patients in detail on the inherent risks of nerve damage during dental and oromaxillofacial procedures. Every surgery should be preceded by a risk-benefit assessment in order to avoid unnecessary nerve damage.
本研究旨在评估创伤性三叉神经感觉根神经病（PTTN）患者的直接医疗成本，并比较暂时性和持续性（>3 个月）PTTN 患者的医疗服务使用情况、药物使用和成本。本研究使用了比利时一家三级口腔颌面疼痛诊所的 PTTN 患者的临床前数据集，包括症状和生活质量评估。在发病后 5 年内，通过比利时最大的健康保险公司获得了成本和资源利用数据。共分析了 158 例患者的数据。损伤后第一年每位患者的平均成本为 2353 欧元（IQR 1426-4499），自付费用占总成本的 25%。住院和技术干预是累积成本的主要驱动因素，其次是咨询费用。对于每个成本类别，持续性 PTTN 患者的支出明显高于暂时性 PTTN 患者（持续性 PTTN 患者 5 年的总费用中位数为 8866 欧元（IQR 4368-18191），而暂时性 PTTN 患者为 4432 欧元（IQR 2156-9032），p<0.001）。PTTN 患者反复且频繁进行头颈部影像学检查（每位患者的影像学检查次数平均为 10±12 次）。药物使用量较高，持续性 PTTN 患者不合理地更多使用阿片类药物和抗生素。在本研究的限制范围内，似乎有必要详细告知患者在牙科和口腔颌面手术中神经损伤的固有风险。每次手术都应进行风险效益评估，以避免不必要的神经损伤。
