Role of novel policy implementation for Gamma Knife (GK) procedures in improving access to neurosurgical care in lower middle income countries (LMICs) GK in LMICs

Bhavya Pahwa; Deepak Agrawal

doi:10.1016/j.wnsx.2023.100166

Role of novel policy implementation for Gamma Knife (GK) procedures in improving access to neurosurgical care in lower middle income countries (LMICs) GK in LMICs

World Neurosurg X. 2023 Jan 31:18:100166. doi: 10.1016/j.wnsx.2023.100166. eCollection 2023 Apr.

Authors

Bhavya Pahwa¹, Deepak Agrawal²

Affiliations

¹ Medical Student, University College of Medical Sciences, Delhi, India.
² Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background: The high cost of GK machines with resultant scarcity of GK centers, coupled to additional cost of contrast MRI brain makes it nearly impossible for the vast majority of the population without health insurance in LMICs to have access to this advancement in management.

Methods: AIIMS, Delhi is the premier public funded hospital in India with the largest Neurosurgical department in the country. We implemented a single payment policy which would cover the treatment and all subsequent GK treatments as well as Follow-up MRIs of the patient. The program was named 'Gamma Knife for life' and implemented in 2015. To check the efficacy, we conducted a retrospective analysis of the Neurosurgery cases managed before and after the implementation of this scheme in the last 12 years.

Results: Prior to implementation of the 'Gamma Knife for life' program, a total of 24,703 patients underwent Neurosurgical procedures in the years 2009-2015. Of these, only 2017 (8.16%) were GK procedures. In the years following the introduction of the program, the total number of neurosurgical procedures was 23,030 with 2947 (12.8%) being the GK procedures This difference in the number of GK procedures before and after the application of 'Gamma Knife for Life' was statistically significant (p = 0.026). The highest number of GK procedures (n = 789) reported so far were in 2020-21.

Conclusions: Ensuring holistic care by providing for not only the initial GK procedure but all subsequent procedures, as well as follow-up MRI's can improve the quality and consistency of care, especially in LMICs.

Keywords: Arteriovenous malformations (AVMs), Gamma knife (GK); Gamma knife radiosurgery; International Atomic Energy Agency (IAEA), Lower middle income countries (LMICs); Lower middle income countries; MRI; Magnetic resonance imaging (MRI), Operating room (OR).