Comparative effectiveness of one versus two-stage sacral neurostimulation device placement

Area of Science:

• Urology
• Health Economics
• Medical Technology Assessment

Background:

• Sacral neurostimulation (SNS) is a recognized third-line therapy for overactive bladder.
• The traditional SNS procedure involves a two-stage approach: initial lead placement followed by permanent device implantation.
• Variations in patient selection and procedural success rates necessitate cost-effectiveness analyses.

Purpose of the Study:

• To compare the cost-effectiveness of a standard two-stage SNS device placement versus a combined one-stage placement.
• To utilize a Markov chain model to evaluate the economic implications of different SNS procedural approaches.

Main Methods:

• A Markov chain model was employed to simulate patient pathways for both two-stage and one-stage SNS procedures.
• Costs were calculated based on Medicare outpatient reimbursement rates, encompassing physician, anesthesia, facility, and device fees.
• The model incorporated costs for lead placement, permanent generator implantation, and lead/generator removal for both successful and unsuccessful outcomes.

Main Results:

• The initial cost for two-stage lead placement was $6,170, with a subsequent $18,474 for permanent implantation upon successful conversion, or $2,879 for lead removal if unsuccessful.
• The one-stage procedure cost $18,474 for simultaneous lead and generator placement, with removal costs of $5,758 for unsuccessful outcomes.
• A one-stage approach was determined to be more cost-effective when the conversion rate from the testing phase to permanent placement exceeded 71%.

Conclusions:

• The cost-effectiveness of one-stage versus two-stage sacral neurostimulation is contingent upon the successful conversion rate.
• Identifying patients with favorable risk factors for successful SNS outcomes is crucial for determining candidacy for a one-stage procedure.