Cedars Sinai Medical Center, Division of Urology Los Angeles, Los Angeles, California.
Neurourol Urodyn. 2019 Feb;38(2):734-739. doi: 10.1002/nau.23908. Epub 2019 Jan 8.
Sacral neurostimulation (SNS) is an effective third-line treatment for overactive bladder. We sought to compare the cost of standard two-stage SNS device placement to that of a combined one-stage placement using a Markov chain model.
Costs were defined using Medicare outpatient reimbursement rates. The model was developed as follows: With the two-stage approach, patients underwent initial lead placement with fluoroscopy and those who converted to stage two underwent permanent generator placement week later. Patients who did not convert underwent lead removal. Patients undergoing a one-stage procedure had initial lead and generator placement at the same time. Patients with success underwent no further procedure. Patients without success could opt for generator and lead removal. Cost effectiveness of one versus two-stage placement depended on successful conversion rate.
Reimbursement included physician, anesthesia, facility and device fees. In a two-stage procedure, initial cost of lead placement was $6170. With successful conversion, cost of a second procedure with permanent lead and generator placement was $18,474. Patients who failed test phase underwent lead removal for a cost of $2879. In a one-stage procedure approach, initial cost of permanent lead and generator placement was $18,474. Patients with a successful outcome had no additional costs. Patients with an unsuccessful outcome could have the lead and generator removal for a cost of $5758. If the conversion rate from testing phase to permanent placement was greater than 71%, a one-stage approach proved to be cost effective.
Identifying patients with favorable risk factors for success may predict those patients who warrant a one-stage approach.
骶神经刺激（SNS）是治疗膀胱过度活动症的有效三线治疗方法。我们旨在比较标准两阶段 SNS 设备放置与使用马尔可夫链模型的联合一阶段放置的成本。
使用医疗保险门诊报销率来定义成本。该模型的开发如下：在两阶段方法中，患者首先进行透视引导的初始引线放置，那些转为第二阶段的患者在一周后进行永久性发生器放置。未转换的患者进行引线移除。接受一阶段手术的患者同时进行初始引线和发生器放置。成功的患者无需进行进一步的手术。不成功的患者可以选择移除发生器和引线。一阶段与两阶段放置的成本效益取决于成功转换率。
报销包括医生、麻醉、设施和设备费用。在两阶段手术中，初始引线放置的成本为 6170 美元。如果成功转换，带有永久性引线和发生器放置的第二次手术的成本为 18474 美元。在测试阶段失败的患者需要进行引线移除，费用为 2879 美元。在一阶段手术中，永久性引线和发生器放置的初始成本为 18474 美元。成功的患者没有额外的费用。不成功的患者可以进行引线和发生器移除，费用为 5758 美元。如果从测试阶段到永久性放置的转换率大于 71%，则一阶段方法具有成本效益。
确定具有成功有利风险因素的患者可能预测那些需要一阶段方法的患者。
