Dickerson David M, Kalia Hemant, Vorenkamp Kevin E, Slavin Konstantin V, Hagedorn Jonathan M, Gunnarsson Candace, Keuffel Eric L, Epstein Andrew J, Stultz Mark, Crosby Nathan D
Department of Anesthesiology, Critical Care, and Pain Medicine, Endeavor Health, Evanston, IL, USA.
Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, IL, USA.
Pain Ther. 2025 Feb;14(1):269-282. doi: 10.1007/s40122-024-00677-4. Epub 2024 Nov 26.
This study evaluates the financial impact on healthcare payers when chronic pain patients initiate peripheral nerve stimulation (PNS) with a 60-day percutaneous PNS (60-Day PNS) treatment versus a conventional brief PNS trial (PNS-BT) with possible follow-on of a permanently implanted PNS system (PNS-PI).
Centers for Medicare & Medicaid Services (CMS) fee-for-service (FFS) data were analyzed to identify patients with at least 12 months of follow-up (median 26.4 months) who initiated PNS treatment with: (1) 60-Day PNS or (2) PNS-BT. An economic decision tree model assessed the cost to payers in each cohort. Clinical response to 60-Day PNS was estimated by retrospectively reviewing anonymized outcomes from a national real-world database, focusing on patients ≥ 65 years of age who were implanted with a 60-day percutaneous PNS system. For the economic model, a Monte Carlo simulation with 10,000 iterations was used to generate 95% confidence intervals, considering variability in treatment outcome probability and costs.
Based on CMS data, among 60-Day PNS patients, 18% (229/1265) proceeded to a permanently implanted PNS system with a 4% explant rate (10/229). Among PNS-BT patients, 41% (1140/2811) received a permanent implant with a 7% rate of explant (77/1140). Estimated PNS-related weighted average costs for the 60-Day PNS cohort [US$17,344; 95% confidence interval (CI): $16,168-$18,527] were lower than the PNS-BT cohort ($24,392; 95% CI $22,865-$25,941) when considering the percent of patients who advanced to a permanently implanted PNS system. The total cost per successful outcome also favored 60-Day PNS ($25,228 per success for the 60-Day PNS cohort vs. $64,502 per success for the PNS-BT cohort) as a first-line approach in PNS treatment.
The findings suggest that, when PNS for chronic pain is warranted, initiating PNS with a 60-day treatment is more cost-effective than utilizing a brief conventional trial.
本研究评估了慢性疼痛患者开始接受为期60天的经皮外周神经刺激（60天PNS）治疗与传统短暂外周神经刺激试验（PNS-BT）并可能后续植入永久性外周神经刺激系统（PNS-PI）时，对医疗保健支付方的财务影响。
分析了医疗保险和医疗补助服务中心（CMS）的按服务收费（FFS）数据，以确定至少有12个月随访期（中位数为26.4个月）且开始接受以下外周神经刺激治疗的患者：（1）60天PNS或（2）PNS-BT。一个经济决策树模型评估了每个队列中支付方的成本。通过回顾一个全国性真实世界数据库中的匿名结果来估计60天PNS的临床反应，重点关注年龄≥65岁且植入了60天经皮外周神经刺激系统的患者。对于经济模型，使用了10000次迭代的蒙特卡洛模拟来生成95%置信区间，同时考虑治疗结果概率和成本的变异性。
根据CMS数据，在60天PNS患者中，18%（229/1265）继续接受永久性外周神经刺激系统植入，其中取出率为4%（10/229）。在PNS-BT患者中，41%（1140/2811）接受了永久性植入，取出率为7%（77/1140）。考虑到进展至永久性外周神经刺激系统植入的患者百分比，60天PNS队列的估计外周神经刺激相关加权平均成本[17344美元；95%置信区间（CI）：16168 - 18527美元]低于PNS-BT队列（24392美元；95% CI 22865 - 25941美元）。作为外周神经刺激治疗的一线方法，每成功治疗一例的总成本也更倾向于60天PNS（60天PNS队列每成功一例为25228美元，而PNS-BT队列每成功一例为64502美元）。
研究结果表明，当有必要使用外周神经刺激治疗慢性疼痛时，开始为期60天的外周神经刺激治疗比采用传统短暂试验更具成本效益。
