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Published on: June 26, 2018
Societal Cost Analysis of Spinal Cord Stimulation in Chronic Pain Patients: A Danish Register-Based Study With
Kaare Meier1,2, Bettina Wulff Risør3,4, Dennis Møgeltoft Poulsen1
1Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
Background:
Spinal cord stimulation (SCS) constitutes a treatment option for patients with severe chronic pain responding insufficiently to pharmacological treatment. High device costs and expenses associated with surgical procedures and follow-up constitute a barrier to adoption. However, CNP patients also constitute a significant burden on public finances, with high public costs relating to health care utilisation, medicine, and lost work capacity.
Methods:
We investigated the costs of SCS therapy from a healthcare perspective (primary and secondary healthcare and medicine costs) 3 years before and 3 years after initiation of the SCS therapy in a large, mixed, well-characterised patient cohort derived from a dedicated neuromodulation registry, including patients with different diagnoses and characteristics from three of the four Danish SCS centers. We additionally compared costs of productivity loss for patients under the age of retirement. Data on societal costs were retrieved from public Danish registries.
Results:
Three hundred and eight-four patients were included. Total healthcare costs 3 years after SCS were significantly higher than 3 years before SCS, with an increase of €29,835. The expenses associated with establishing SCS therapy are reflected in a sharp increase in in-patient secondary health care cost in year one after SCS. Primary health care, secondary out-patient health care and medicine costs all decrease after SCS but not enough to compensate for the cost of establishing treatment. Costs due to productivity loss remain stable throughout the period.
Conclusions:
Our findings highlight evaluating high-cost interventions within a broader cost framework to inform more efficient resource allocation in chronic pain management.
Significance:
This study analyzes the real-world socioeconomic impact of spinal cord stimulation (SCS) in Denmark. By using data from public Danish registries, we find a sharp increase in in-hospital expenses at the year of implantation, only partially offset by a subsequent reduction in other health care expenses and medicine costs. These findings give unique insights into the financial aspects of SCS, offering a perspective for healthcare providers, policymakers, and patients when evaluating the long-term budgetary implications of this treatment.
