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Earlier spinal cord stimulation may help offset increased health care utilization and costs
WASHINGTON — Results of a retrospective study presented at the American Association of Neurological Surgeons Annual Meeting, here, showed a longer delay from the time a patient is diagnosed with back pain to when they have a spinal cord stimulator implanted is associated with increased utilization of health care services in the first year after the stimulator is implanted.
According to Frank W. Petraglia III, BS, and colleagues, implementing spinal cord stimulation (SCS) earlier could help reduce the health care financial burden for their patients.
“We found the mean pain-to-SCS time in our study was actually 1.39 years, which is lower than has been previously reported in the literature,” Petraglia said. “Longer pain-to-SCS times resulted in significant increases in health care utilization in inpatient and outpatient medical expenditures, pharmaceutical payments, opioid payments, prescriptions filled, and office and hospital visits.”
Petraglia and colleagues retrospectively analyzed claims data for patients included in the Truven Health MarketScan Database between April 1, 2008, and March 31, 2013, who underwent permanent SCS implantation after a 300-day pain-free period. The researchers aimed to determine health care utilization within 1 year after SCS implantation to see whether utilization rates increased with a protracted time to SCS implantation.
Among the health care utilization events analyzed were inpatient and outpatient medical expenditures and costs for hospital, emergency room and office visits. Expenses for these services were grouped into low, medium and high expenditures ranging from $0 to $650 for the low group to $4,255 to $359,084 for the high group.
The study included 762 patients with a mean age of 55.9 years; 41% of patients were men. The patients’ average Charlson Comorbidity Index score was 0.46, and 13% of patients underwent back surgery within the study period.
Logistic regression analysis showed pain-to-SCS time had a significant effect on the utilization group into which the patients fell, according to Petraglia.
“We found for inpatient and outpatient expenditures a 1-year increase in pain-to-SCS time increased the odds of falling into the high health care utilization group over the low group by 33%,” he said.
The retrospective, nonrandomized study design was considered a limitation of the study. Additionally, because patients were selected for enrollment by their ICD-9 and CPTS codes, there was a chance patients were excluded from the study due to miscoding errors, Petraglia said.
“We had no access to patient-reported pain scores following surgery,” he said. “For a retrospective study, there is an overall small number of events in 762 patients.”
Petraglia concluded that despite these limitations, he and colleagues felt their findings supported those presented in previous research, which indicated that the efficacy of SCS was inversely proportional to pain-to-SCS time.
“We also believe earlier implantation of SCS could help offset the initial cost of implantation through decreased health care utilization following the implantation,” he said. “It is important for all providers who care for patients with chronic pain be aware of the role of SCS in treating chronic pain, because considering SCS earlier in the care continuum may help reduce the economic health care burden of patients with chronic pain.”
Petraglia received the William H. Sweet Young Investigators Award for this research. – by Susan M. Rapp
References:
Petraglia FW, et al. Paper #729. Presented at: American Association of Neurological Surgeons Annual Meeting. May 2-6, 2015; Washington, D.C.
Disclosure: Petraglia reports no relevant financial disclosures and he reports the study was partially funded by St. Jude Medical.