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高频脊髓刺激治疗糖尿病性周围神经痛的医疗经济学

Healthcare Economics of High Frequency Spinal Cord Stimulation for Painful Diabetic Peripheral Neuropathy.

机构信息

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.

出版信息

J Diabetes Sci Technol. 2024 May;18(3):635-643. doi: 10.1177/19322968221128321. Epub 2022 Oct 31.

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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%.

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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%。

结论

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。

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