Provenzano David A, Falowski Steven M, Xia Ying, Doth Alissa H
Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
Neurosurgical Associates of Lancaster, Lancaster, PA, USA.
Neuromodulation. 2019 Apr;22(3):302-310. doi: 10.1111/ner.12939. Epub 2019 Mar 13.
Surgical site infections (SSIs) result in significant negative clinical and economic outcomes. The objective of this study is to estimate annual health expenditures associated with spinal cord stimulation (SCS)-related infections.
Data from the Truven MarketScan® databases were used to identify patients with an SCS implant (2009-2014) and a continuous health plan enrollment for at least 12-months before and after implant (index date). Annual expenditures were estimated for patients with a device-related infection vs. those without infection since index date. A generalized linear model estimated annual expenditures attributable to device-related infection. Multivariable expenditure models were conducted separately for patients in initial and replacement groups, controlling for demographics, comorbidities, and clinical characteristics.
The study included 6615 patients. Multivariable expenditure models revealed that patients with infection have higher annual expenditures than patients without infection. Estimated incremental annual healthcare expenditures for patients with an infection were $59,716 (95% CI: $48,965-$69,480) for initial implanted patients and $64,833 (95% CI: $37,377-$86,519) for replacement patients. Only 26% of patients who were explanted for infection underwent a reimplant.
These results show the substantial expenditure burden associated with an SCS-related infection. Management of SCS-related infection is important from both clinical and economic standpoints. The economic and clinical data presented here reinforce the need for additional research and strategies for healthcare providers to minimize SCS infections. Future economic research is needed to further define the specific economic cost drivers associated with the extensive expenditure burden.
手术部位感染（SSIs）会导致显著的负面临床和经济后果。本研究的目的是估计与脊髓刺激（SCS）相关感染相关的年度医疗支出。
使用来自Truven MarketScan®数据库的数据，识别接受SCS植入的患者（2009 - 2014年），以及在植入前后（索引日期）至少连续参加健康计划12个月的患者。估计自索引日期起发生与设备相关感染的患者与未感染患者的年度支出。采用广义线性模型估计与设备相关感染所致的年度支出。针对初始组和置换组患者分别建立多变量支出模型，控制人口统计学、合并症和临床特征。
该研究纳入了6615例患者。多变量支出模型显示，感染患者的年度支出高于未感染患者。对于初始植入患者，感染患者估计的年度医疗保健增量支出为59,716美元（95%置信区间：48,965 - 69,480美元）；对于置换患者，为64,833美元（95%置信区间：37,377 - 86,519美元）。因感染而取出设备的患者中，只有26%接受了重新植入。
这些结果表明与SCS相关感染相关的巨大支出负担。从临床和经济角度来看，管理SCS相关感染都很重要。此处呈现的经济和临床数据强化了医疗服务提供者开展更多研究和采取策略以尽量减少SCS感染的必要性。未来需要进行经济研究，以进一步确定与广泛支出负担相关的具体经济成本驱动因素。
