Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Health Economics and Outcomes Research, St. Jude Medical, Sylmar, CA, USA.
Neuromodulation. 2016 Jul;19(5):469-76. doi: 10.1111/ner.12389. Epub 2016 Feb 29.
A shorter delay time from chronic pain diagnosis to spinal cord stimulation (SCS) implantation may make it more likely to achieve lasting therapeutic efficacy with SCS. The objective of this analysis was to determine the impact of pain-to-SCS time on patients' post-implant healthcare resource utilization (HCRU).
A retrospective observational study was performed using a real-world patient cohort derived from MarketScan(®) Commercial and Medicare Supplemental claims data bases from April 2008 through March 2013. The predictor variable was the time from the first diagnosis of chronic pain to permanent SCS implant. Using multivariable analysis, we studied the impact of pain-to-SCS time on HCRU in the first year post-implant. For some regression tests, patients were grouped into terciles by HCRU.
A total of 762 patients met inclusion criteria, with a median pain-to-SCS time of 1.35 years (Q1: 0.8, Q3: 1.9). For every one-year increase in pain-to-SCS time, the odds increased by 33% for being in the high medical expenditures group (defined using the upper tercile: $4133 over above) over the low group (first lower: $603 or less). The odds increased by 39% for being in the high opioid prescriptions group (10-58 prescriptions) over the low group (0-1). The odds increased by 44% and 55%, respectively, for being in the high office visits (8-77) or hospitalizations (3-28) group over the low office visits (0-2) or hospitalizations (0) group.
HCRU increased in the year following SCS implantation with longer pain-to-SCS time. These results suggest that considering SCS earlier in the care continuum for chronic pain may improve patient outcomes, with reductions in hospitalizations, clinic visits, and opioid usage.
慢性疼痛诊断后至脊髓刺激（SCS）植入的时间越短，SCS 实现持久治疗效果的可能性就越大。本分析的目的是确定疼痛至 SCS 时间对患者植入后医疗保健资源利用（HCRU）的影响。
使用来自 MarketScan（®）商业和医疗保险补充数据库的真实患者队列进行回顾性观察性研究，时间为 2008 年 4 月至 2013 年 3 月。预测变量是从慢性疼痛首次诊断到永久性 SCS 植入的时间。使用多变量分析，我们研究了植入后第一年疼痛至 SCS 时间对 HCRU 的影响。对于一些回归测试，根据 HCRU 将患者分为三分位数组。
共有 762 名患者符合纳入标准，疼痛至 SCS 时间的中位数为 1.35 年（Q1：0.8，Q3：1.9）。每增加一年疼痛至 SCS 的时间，在高医疗支出组（定义为上三分位数：超过$4133）中而不是低支出组（第一低：$603 或更少）的几率增加 33%。在高阿片类药物处方组（10-58 张处方）中而不是低处方组（0-1）的几率增加 39%。在高门诊就诊（8-77）或住院（3-28）组中而不是低门诊就诊（0-2）或住院（0）组的几率分别增加 44%和 55%。
随着疼痛至 SCS 时间的延长，SCS 植入后一年的 HCRU 增加。这些结果表明，在慢性疼痛的护理连续体中更早考虑 SCS 可能会改善患者的预后，减少住院、就诊和阿片类药物的使用。
