All-in-one spinal cord stimulation and its economic impact

OBJECTIVES: This study estimates the economic and organizational impact of adopting the All-in-One Spinal Cord Stimulation (SCS) implantation strategy compared to the traditional two-stage approach for chronic pain patients in Spain. We assess savings, resource utilization, and the success rate threshold above which it would be more profitable to perform the procedure in a single phase. METHODS: A retrospective study analyzed Real-World Data (RWD) from chronic pain patients treated with SCS between 2012 and 2023. Data included socio-demographics, resource use, and post-implant procedures. A health-economic cost model was developed using RWD results to estimate cost differences between the two approaches over a one-year follow-up. The test phase success rate threshold that equalizes costs between strategies was also determined. RESULTS: A total of 132 patients met inclusion criteria (94 two-stage, 38 All-in-One). The All-in-One group had shorter hospital stays (0.6 vs. 1.6 days), operating room time (1.8 vs. 3.2 h), and no post-implant interventions (vs. 15 in the two-stage group). Infection rates were significantly lower in the All-in-One group (0% vs. 8.5%). The cost model estimated savings of €3,217 per patient, driven by reductions in infections (67.5%), procedural costs (11.8%), and hospital stay (9.1%). A 76.6% test phase success rate was determined as the economic equivalence threshold. CONCLUSION: The All-in-One SCS strategy offers significant economic advantages, reducing costs, resource use, and infection rates compared to the two-stage approach. Given the high success rates of the test phase in Europe, hospitals with high success rates should consider transitioning to the All-in-One approach.