Department of Neurosurgery, Duke University Hospital, Duke University Medical Center, Duke University School of Medicine, Durham, NC, USA.
Department of Biostatistics, Duke University, Durham, NC, USA.
J Diabetes Sci Technol. 2024 May;18(3):635-643. doi: 10.1177/19322968221128321. Epub 2022 Oct 31.
Painful diabetic peripheral neuropathy (pDPN) is a debilitating complication of long-term diabetes. High-frequency spinal cord stimulation (HF-SCS) was recently shown to be an effective treatment option, but the associated healthcare resource utilization (HCRU) on real-world patient populations with pDPN is unknown.
Using IBM MarketScan databases, we identified patients with HF-SCS implantation between January 2016 and December 2019 who had a diagnosis of diabetes or diabetic neuropathy within two years before implant. Cost data were collected for the six months before HF-SCS implantation (baseline) and for the periods of one, three, and six months post-implantation. The six-month explant rate was calculated.
A total of 132 patients met inclusion criteria. The median total cost at baseline was $19 220 and was $1356 at one month post-implant, $4858 at three months post-implant, and $13 305 at six months post-implant. The median baseline out-of-pocket cost was $1477 and was $710 at six months post-implant. The average total cost reduction from baseline to six months post-implant was $5118 ( < .001), or $853 per month. The median device acquisition cost was $35 755. The explant rate within six months was 2.1%.
High frequency spinal cord stimulation significantly reduces total HCRU in patients with pDPN, and based on the average monthly cost reduction of $853, we estimate that the therapy recoups acquisition costs within 3.5 years. As policy increasingly focuses on value-based care, it will be critical to consider the cost and outcomes of innovative therapies.
痛性糖尿病周围神经病变(pDPN)是长期糖尿病的一种使人衰弱的并发症。高频脊髓刺激(HF-SCS)最近被证明是一种有效的治疗选择,但在患有 pDPN 的真实世界患者群体中,其相关的医疗资源利用(HCRU)尚不清楚。
我们使用 IBM MarketScan 数据库,确定了在 2016 年 1 月至 2019 年 12 月期间接受 HF-SCS 植入术的患者,这些患者在植入前两年内有糖尿病或糖尿病周围神经病变的诊断。在 HF-SCS 植入前六个月(基线期)以及植入后一个、三个月和六个月的时间段内收集成本数据。计算了六个月的器械取出率。
共有 132 名患者符合纳入标准。基线时的总中位成本为 19220 美元,植入后一个月为 1356 美元,三个月为 4858 美元,六个月为 13305 美元。基线期外付费用的中位数为 1477 美元,植入后六个月为 710 美元。与基线相比,植入后六个月的平均总成本降低了 5118 美元( <.001),即每月 853 美元。设备购置费用的中位数为 35755 美元。六个月内的器械取出率为 2.1%。
高频脊髓刺激显著降低了 pDPN 患者的总 HCRU,根据平均每月 853 美元的成本降低,我们估计该疗法在 3.5 年内可收回购置成本。随着政策越来越关注基于价值的医疗保健,考虑创新疗法的成本和结果将至关重要。