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Observational Study
. 2016 Jul;19(5):469-76.
doi: 10.1111/ner.12389. Epub 2016 Feb 29.

Longer Delay From Chronic Pain to Spinal Cord Stimulation Results in Higher Healthcare Resource Utilization

Shivanand P Lad  1 , Frank W Petraglia 3rd  1 , Alexander R Kent  2 , Steven Cook  1 , Kelly R Murphy  1 , Nirav Dalal  2 , Edward Karst  2 , Peter Staats  3 , Ashwini Sharan  4
Affiliations
Observational Study

Longer Delay From Chronic Pain to Spinal Cord Stimulation Results in Higher Healthcare Resource Utilization

Shivanand P Lad et al. Neuromodulation. 2016 Jul.

Abstract

Introduction: A shorter delay time from chronic pain diagnosis to spinal cord stimulation (SCS) implantation may make it more likely to achieve lasting therapeutic efficacy with SCS. The objective of this analysis was to determine the impact of pain-to-SCS time on patients' post-implant healthcare resource utilization (HCRU).

Methods: A retrospective observational study was performed using a real-world patient cohort derived from MarketScan(®) Commercial and Medicare Supplemental claims data bases from April 2008 through March 2013. The predictor variable was the time from the first diagnosis of chronic pain to permanent SCS implant. Using multivariable analysis, we studied the impact of pain-to-SCS time on HCRU in the first year post-implant. For some regression tests, patients were grouped into terciles by HCRU.

Results: A total of 762 patients met inclusion criteria, with a median pain-to-SCS time of 1.35 years (Q1: 0.8, Q3: 1.9). For every one-year increase in pain-to-SCS time, the odds increased by 33% for being in the high medical expenditures group (defined using the upper tercile: $4133 over above) over the low group (first lower: $603 or less). The odds increased by 39% for being in the high opioid prescriptions group (10-58 prescriptions) over the low group (0-1). The odds increased by 44% and 55%, respectively, for being in the high office visits (8-77) or hospitalizations (3-28) group over the low office visits (0-2) or hospitalizations (0) group.

Conclusions: HCRU increased in the year following SCS implantation with longer pain-to-SCS time. These results suggest that considering SCS earlier in the care continuum for chronic pain may improve patient outcomes, with reductions in hospitalizations, clinic visits, and opioid usage.

Keywords: Chronic pain; healthcare costs; healthcare utilization; outcomes; spinal cord stimulation.

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Figures

Figure 1
Figure 1
Flow chart of numbers of patients that met inclusion/exclusion criteria.
Figure 2
Figure 2
Histogram of distribution of pain-to-SCS procedure time for patients included in the study. The three vertical lines show the median, lower quartile, and upper quartile.
Figure 3
Figure 3
Percentage of patients in low, medium, and high utilization groups for all HCU variables. Patients are binned into one of four pain-to-SCS procedure time groups (0-1 years, 1-2 years, 2-3 years, >3 years).
See this image and copyright information in PMC

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