Department of Urology, UCLA, Los Angeles, CA, USA; Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Neuromodulation. 2014 Jan;17(1):72-4; discussion 74. doi: 10.1111/ner.12062. Epub 2013 May 3.
Sacral neuromodulation is Food and Drug Administration approved for many types of voiding dysfunction. Goals of treatment often include cessation of anticholinergic therapy. With the goal of understanding the impact of sacral neuromodulation on anticholinergic use, we analyzed patterns of care using a national claims-based dataset.
The Ingenix (i3) data base contains insurance claims, including utilization and cost data, for 75 large employers. De-identified patients who underwent sacral neuromodulation between 2002 and 2007 were identified by the unique current procedural terminology-4 procedure code for pulse generator implantation, code 64590. The number and costs of anticholinergic prescriptions were compared before and after treatment.
There were 266 percutaneous and 794 two-staged procedures performed from 2002 to 2007 in the i3 dataset. A total of 484 pulse generator implantations were performed, representing 46% of the test procedures. During the year prior to pulse generator placement, each patient purchased an average of 2.1 prescriptions for an anticholinergic agent (SD 3.5). During the year after neuromodulation, each patient purchased an average of 1.0 prescription (SD 2.3, p < 0.0001 by t-test). Prescription charges were $241.31 per patient before and $103.52 after neuromodulation, a statistically significant cost difference (p < 0.0001 by t-test). During the year before the procedure, 50% of patients filled anticholinergic prescriptions. This decreased to 23% after the procedure (p < 0.0001 by chi-square test).
Sacral neuromodulation was associated with a significant decrease in the use of anticholinergic medication. Cost-effectiveness analyses that take into account patient quality-adjusted life years are needed to determine the true cost-benefit ratio of sacral neuromodulation.
骶神经调节已获得美国食品和药物管理局批准，可用于多种类型的排尿功能障碍。治疗目标通常包括停止使用抗胆碱能药物。为了了解骶神经调节对抗胆碱能药物使用的影响，我们使用全国索赔为基础的数据集分析了护理模式。
Ingenix(i3)数据库包含了 75 家大型雇主的保险索赔，包括利用和成本数据。通过独特的当前操作术语-4 程序代码，即脉冲发生器植入的代码 64590，对 2002 年至 2007 年间接受骶神经调节的患者进行了鉴定。在治疗前后，比较了抗胆碱能药物的处方数量和费用。
i3 数据集中，2002 年至 2007 年期间共进行了 266 例经皮和 794 例两阶段手术。共进行了 484 例脉冲发生器植入术，占测试手术的 46%。在放置脉冲发生器之前的一年中，每位患者平均购买了 2.1 种抗胆碱能药物的处方（标准差 3.5）。在神经调节后一年，每位患者平均购买了 1.0 种处方（标准差 2.3，t 检验 p <0.0001）。在神经调节之前，每位患者的处方费用为 241.31 美元，之后为 103.52 美元，统计学上有显著差异（t 检验 p <0.0001）。在手术前一年，50%的患者服用了抗胆碱能药物。手术后这一比例下降到 23%（卡方检验 p <0.0001）。
骶神经调节与抗胆碱能药物使用的显著减少相关。需要进行考虑患者质量调整生命年的成本效益分析，以确定骶神经调节的真正成本效益比。
