Abstract
Objective
High-frequency spinal cord stimulation (HF-SCS) is a treatment option for postsurgical
persistent spinal pain syndrome (type 2 PSPS). We aimed to determine the health care
costs associated with this therapy in a nationwide cohort.
Materials and Methods
IBM Marketscan® Research Databases were used to identify patients who underwent HF-SCS
implantation from 2016 to 2019. Inclusion criteria included prior spine surgery or
diagnoses of PSPS or postlaminectomy pain syndrome any time within the two years before
implantation. Inpatient and outpatient service costs, medication costs, and out-of-pocket
costs were collected six months before implantation (baseline) and one, three, and
six months after implantation. The six-month explant rate was calculated. Costs were
compared between baseline and six months after implant via Wilcoxon sign rank test.
Results
In total, 332 patients were included. At baseline, patients incurred median total
costs of $15,393 (Q1: $9,266, Q3: $26,216), whereas the postimplant median total costs
excluding device acquisition were $727 (Q1: $309, Q3: $1,765) at one month, $2,840
(Q1: $1,170, Q3: $6,026) at three months, and $6,380 (Q1: $2,805, Q3: $12,637) at
six months. The average total cost was reduced from $21,410 (SD $21,230) from baseline
to $14,312 (SD $25,687) at six months after implant for an average reduction of $7,237
(95% CI = $3212–$10,777, p < 0.001). The median device acquisition costs were $42,937 (Q1: $30,102, Q3: $65,880).
The explant rate within six months was 3.4% (8/234).
Conclusions
HF-SCS for PSPS was associated with significant decreases in total health care costs
and offsets acquisition costs within 2.4 years. With the rising incidence of PSPS,
it will be critical to use clinically effective and cost-efficient therapies for treatment.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe toAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Indications, techniques, and outcomes of posterior surgery for chronic low back pain.Orthop Clin North Am. 2003; 34: 297-308
- Persistent spinal pain syndrome: a proposal for failed back surgery syndrome and ICD-11.Pain Med. 2021; 22: 807-818
- Persistent spinal pain syndrome: new terminology for a new era.J Pain Res. 2021; 14: 1627-1630
- The incidence and healthcare costs of persistent postoperative pain following lumbar spine surgery in the UK: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES).BMJ Open. 2017; 7e017585
- Failed back surgery syndrome.Pain Med. 2011; 12: 577-606
- Treatment options for failed back surgery syndrome patients with refractory chronic pain: an evidence based approach.Spine (Phila Pa 1976). 2017; 42: S41-S52
- Medical management of failed back surgery syndrome in Europe: evaluation modalities and treatment proposals.Neurochirurgie. 2015; 61: S57-S65
- Spinal cord stimulation: clinical efficacy and potential mechanisms.Pain Pract. 2018; 18: 1048-1067
- Comparison of 10-kHz high-frequency and traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: 24-month results from a multicenter, randomized, controlled pivotal trial.Neurosurgery. 2016; 79: 667-677
- Novel 10-kHz high-frequency therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial.Anesthesiology. 2015; 123: 851-860
- Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial.Neurosurgery. 2005; 56 ([discussion: 106–107]): 98-106
- An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management.Neuromodulation. 2010; 13: 201-209
- Systematic review of the (cost-)effectiveness of spinal cord stimulation for people with failed back surgery syndrome.Clin J Pain. 2008; 24: 741-756
- Spinal cord stimulation in failed back surgery syndrome: review of clinical use, quality of life and cost-effectiveness.Asian Spine J. 2016; 10: 1195-1204
- A systematic review of the cost-utility of spinal cord stimulation for persistent low back pain in patients with failed back surgery syndrome.Global Spine J. 2021; 11: 66S-72S
- Quality of life, resource consumption and costs of spinal cord stimulation versus conventional medical management in neuropathic pain patients with failed back surgery syndrome (PROCESS trial).Eur J Pain. 2008; 12: 1047-1058
- Cost-effectiveness data regarding spinal cord stimulation for low back pain.Spine (Phila Pa 1976). 2017; 42: S72-S79
- Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: an observational study in a workers’ compensation population.Spine (Phila Pa 1976). 2011; 36: 2076-2083
- Cost effectiveness of a novel 10 kHz high-frequency spinal cord stimulation system in patients with failed back surgery syndrome (FBSS).J Long Term Eff Med Implants. 2014; 24: 173-183
- Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015.Spine (Phila Pa 1976). 2019; 44: 369-376
- Persistent spinal pain syndrome type 2 (PSPS-T2), a social pain? Advocacy for a social gradient of health approach to chronic pain.J Clin Med. 2021; 10: 2817
- Effect of high-frequency (10-kHz) spinal cord stimulation in patients with painful diabetic neuropathy: a randomized clinical trial.JAMA Neurol. 2021; 78: 687-698
- Randomized prospective study in patients with complex regional pain syndrome of the upper limb with high-frequency spinal cord stimulation (10-kHz) and low-frequency spinal cord stimulation.Neuromodulation. 2021; 24: 448-458
- Efficacy of 10 kHz spinal cord stimulation in complex regional pain syndrome: a retrospective analysis.Clin Neurol Neurosurg. 2022; 216107220
- A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.Med Care. 2009; 47: 626-633
- New morbidity and comorbidity scores based on the structure of the ICD-10.PLoS One. 2015; 10e0143365
U.S. Department of Health and Human Services. Estimated hypertension prevalence treatment, and control among U.S. adults. Accessed October 4, 2021. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html
- Depression and pain comorbidity: a literature review.Arch Intern Med. 2003; 163: 2433-2445
- Etiology, evaluation, and treatment of failed back surgery syndrome.Asian Spine J. 2018; 12: 574-585
- Utilization of facet joint and sacroiliac joint interventions in Medicare population from 2000 to 2014: explosive growth continues!.Curr Pain Headache Rep. 2016; 20: 58
- Utilization patterns of facet joint interventions in managing spinal pain: a retrospective cohort study in the US fee-for-service Medicare population.Curr Pain Headache Rep. 2019; 23: 73
- The societal impact of pain in the European Union: health-related quality of life and healthcare resource utilization.J Med Econ. 2010; 13: 571-581
- Pain, health related quality of life and healthcare resource utilization in Spain.J Med Econ. 2011; 14: 628-638
- Understanding pain among older persons: part 2-the association between pain profiles and healthcare utilisation.Age Ageing. 2017; 46: 51-56
- Counting the costs: case management implications of spinal cord stimulation treatment for failed back surgery syndrome.Prof Case Manag. 2011; 16: 27-36
- Cost-effectiveness analysis of spinal cord stimulation in treatment of failed back surgery syndrome.J Pain Symptom Manage. 1997; 13: 286-295
- The long-term durability of multilumen concentric percutaneous spinal cord stimulator leads.Pain Pract. 2018; 18: 845-849
- Spinal cord stimulation failure: evaluation of factors underlying hardware explantation.J Neurosurg Spine. 2019; 1–6
- A retrospective database review of the indications, complications, and incidence of subsequent spine surgery in 12,297 spinal cord stimulator patients.Neuromodulation. 2020; 23: 634-638
- Risk factors and survival analysis of spinal cord stimulator explantation.Neuromodulation. 2021; 24: 61-67
Article info
Publication history
Published online: March 03, 2023
Accepted:
January 23,
2023
Received in revised form:
December 20,
2022
Received:
August 31,
2022
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: This study was funded in part by a grant from Nevro Corp. This publication was also made possible in part by grant number UL1TR002553 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCATS or NIH.
Conflict of Interest: Shivanand P. Lad is a consultant at Nevro Corp, which partially funded this work. All other authors reported no conflict of interest.
Identification
Copyright
© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
