Abstract
Introduction
Chronic refractory low back pain (CRLBP) is a diagnosis characterized by chronic low
back pain in patients who are poor candidates for surgery and fail conservative management.
High-frequency spinal cord stimulation (HF-SCS) is a new advance in neuromodulation
that may be effective in treating these patients. However, the cost burden of this
therapy is yet undetermined.
Materials and Methods
IBM MarketScan® (IBM, Armonk, NY) data bases were used to retrospectively identify
patients with HF-SCS implantation between 2016 and 2019 in the United States. Those
with low back pain diagnosis without history of surgery were included in the cohort.
Cost data, including inpatient and outpatient service, medication, and out-of-pocket
costs, were collected at six months before HF-SCS implantation and one, three, and
six months after implantation. The explant rate within six months was evaluated.
Results
A total of 119 patients met the inclusion criteria. Most patients were female (73.1%)
and owned commercial insurance (83.2%). Common comorbidities included inflammatory
arthritis (22.7%), depression (26.1%), hypertension (44.5%), and obesity (26.1%).
In the six months before HF-SCS implantation, patients incurred median total costs
of $15,766 (first quartile [Q1]: $8,847; third quartile [Q3]: $24,947), whereas the
postimplant median total cost excluding device acquisition was $398 (Q1: $145, Q3:
$1,272) at one month, $2,569 (Q1: $823, Q3: $5,266) at three months, and $5,840 (Q1:
$2,160; Q3: $14,607) at six months. The average reduction in total cost was $6,914
(95% CI: $588, $12,458, p < 0.001). The median total acquisition cost was $43,586 (Q1: $29,506, Q3: $69,426),
with most coming from outpatient services. Of 88 patients with six-month continuous
enrollment, two (2.3%) had device explant.
Conclusions
We present an analysis using large claims data bases of the cost of HF-SCS for treating
CRLBP and show that it may be associated with a significant decrease in total health
care costs, offsetting device acquisition costs in 27 months. As advances in neuromodulation
expand therapy options for patients, it will be important to understand their financial
implications.
Keywords
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Comment
Article info
Publication history
Published online: July 20, 2022
Accepted:
March 6,
2022
Received in revised form:
February 16,
2022
Received:
December 18,
2021
Footnotes
Source(s) of financial support: This study was funded with a clinical research grant from Nevro Corp.
Conflict of Interest: This study was funded by a grant from Nevro Corp, for which Shivanand P. Lad is a consultant. The remaining authors reported no conflict of interest.
Identification
Copyright
© 2022 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Response to: “Health Care Resource Utilization of High-Frequency Spinal Cord Stimulation for Treatment of Chronic Refractory Low Back Pain”NeuromodulationVol. 26Issue 3
- PreviewWe read with interest the recent article by Rajkumar et al on the health care resource utilization of high-frequency spinal cord stimulation (HF-SCS) in patients with chronic refractory low back pain (CRLBP).1 Although the authors present some intriguing findings, we believe that there are several limitations to the study that warrant consideration.
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