Rajkumar Shashank, Yang Lexie Zidanyue, Venkatraman Vishal, Charalambous Lefko, Parente Beth, Lee Hui-Jie, Lad Shivanand P
Department of Neurosurgery, Duke University Hospital, Durham, NC, USA.
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
Neuromodulation. 2023 Jan;26(1):115-123. doi: 10.1016/j.neurom.2022.03.013. Epub 2022 Jul 21.
Chronic refractory low back pain (CRLBP) is a diagnosis characterized by chronic low back pain in patients who are poor candidates for surgery and fail conservative management. High-frequency spinal cord stimulation (HF-SCS) is a new advance in neuromodulation that may be effective in treating these patients. However, the cost burden of this therapy is yet undetermined.
IBM MarketScan® (IBM, Armonk, NY) data bases were used to retrospectively identify patients with HF-SCS implantation between 2016 and 2019 in the United States. Those with low back pain diagnosis without history of surgery were included in the cohort. Cost data, including inpatient and outpatient service, medication, and out-of-pocket costs, were collected at six months before HF-SCS implantation and one, three, and six months after implantation. The explant rate within six months was evaluated.
A total of 119 patients met the inclusion criteria. Most patients were female (73.1%) and owned commercial insurance (83.2%). Common comorbidities included inflammatory arthritis (22.7%), depression (26.1%), hypertension (44.5%), and obesity (26.1%). In the six months before HF-SCS implantation, patients incurred median total costs of $15,766 (first quartile [Q1]: $8,847; third quartile [Q3]: $24,947), whereas the postimplant median total cost excluding device acquisition was $398 (Q1: $145, Q3: $1,272) at one month, $2,569 (Q1: $823, Q3: $5,266) at three months, and $5,840 (Q1: $2,160; Q3: $14,607) at six months. The average reduction in total cost was $6,914 (95% CI: $588, $12,458, p < 0.001). The median total acquisition cost was $43,586 (Q1: $29,506, Q3: $69,426), with most coming from outpatient services. Of 88 patients with six-month continuous enrollment, two (2.3%) had device explant.
We present an analysis using large claims data bases of the cost of HF-SCS for treating CRLBP and show that it may be associated with a significant decrease in total health care costs, offsetting device acquisition costs in 27 months. As advances in neuromodulation expand therapy options for patients, it will be important to understand their financial implications.
慢性难治性腰痛（CRLBP）是一种诊断，其特征是慢性腰痛，这类患者不适合手术且保守治疗无效。高频脊髓刺激（HF-SCS）是神经调节领域的一项新进展，可能对治疗这些患者有效。然而，这种治疗的成本负担尚未确定。
使用IBM MarketScan®（IBM，纽约州阿蒙克）数据库回顾性识别2016年至2019年在美国植入HF-SCS的患者。纳入队列的是那些有腰痛诊断且无手术史的患者。收集成本数据，包括住院和门诊服务、药物以及自付费用，分别在HF-SCS植入前六个月以及植入后1个月、3个月和6个月收集。评估六个月内的取出率。
共有119名患者符合纳入标准。大多数患者为女性（73.1%）且拥有商业保险（83.2%）。常见合并症包括炎性关节炎（22.7%）、抑郁症（26.1%）高血压（44.5%）和肥胖症（26.1%）。在HF-SCS植入前的六个月里，患者的总费用中位数为15,766美元（第一四分位数[Q1]：8,847美元；第三四分位数[Q3]：24,947美元），而植入后不包括设备购置的总费用中位数在1个月时为398美元（Q1：145美元，Q3：1,272美元），3个月时为2,569美元（Q1：823美元，Q3：5,266美元），6个月时为5,840美元（Q1：2,160美元；Q3：14,607美元）。总成本平均降低了6,914美元（95%置信区间：588美元，12,458美元，p < 0.001）。设备购置总成本中位数为43,586美元（Q1：29,506美元，Q3：69,426美元），大部分来自门诊服务。在88名连续登记六个月的患者中，有两名（2.3%）进行了设备取出。
我们使用大型理赔数据库对HF-SCS治疗CRLBP的成本进行了分析，结果表明它可能与总体医疗保健成本的显著降低有关，并在27个月内抵消设备购置成本。随着神经调节领域的进展为患者扩展了治疗选择，了解其财务影响将很重要。
