Economic Consequences of an Implanted Neuroprosthesis in Subjects with Spinal Cord Injury for Restoration of an Effective Cough

Abstract

Objective: To determine if an implanted neuroprosthesis for restoration of an effective cough is less costly than conventional methods of respiratory management. Methods: Nonrandomized clinical trial of participants (N = 14) with spinal cord injury (SCI) using the Cough Stimulator device in the inpatient hospital setting for Cough Stimulator implantation and outpatient hospital or residence for follow-up. A neuroprosthesis was implanted for restoration of an effective cough. The annual costs associated with respiratory management, without (pre implantation) and with (post implantation) the neuroprosthesis, were examined over a 4-year period. Results: The total cost related to implantation of the Cough Stimulator was $59,891, with no maintenance costs over subsequent years. The incidence of respiratory tract infections and the need for caregiver support fell significantly following implantation. The costs associated with respiratory tract infections fell significantly from a mean of $36,406 ± 11,855/year to $13,284 ± 7,035/year (p < .05) pre and post implantation, respectively. Costs fell further to $8,817 ± 5,990 and $4,467 ± 4,404 following the 2nd and 3rd years post implantation (p < .05), respectively. The costs associated with caregiver support fell significantly from $25,312 ± 8,019/year to $2,630 ± 2,233/year (p < .05) pre and post implantation, respectively, and remained low in subsequent years (p < .05). Other costs related to secretion management fell significantly and remained low in subsequent years (p < .05). Break-even analysis demonstrated that this point was reached in the first year. Conclusion: The results of this investigation demonstrate that implantation and use of the Cough Stimulator resulted in significant reductions in the overall costs of respiratory management in this patient population.

Keywords: cough; economics; expiratory muscles; rehabilitation; spinal cord stimulation.

Figure 1.

Incidence of respiratory tract infections pre and post implantation and use of the Cough Stimulator. The incidence of respiratory tract infections fell significantly following restoration of an effective cough (*p < .05 if compared to pre implant). See text for further explanation.

Figure 2.

Average need for caregiver support pre and post implantation and use of the Cough Stimulator. The need for caregiver support fell significantly following restoration of an effective cough (*p < .05 if compared to pre implant). See text for further explanation.

Figure 3.

Estimated costs for respiratory management pre and post implantation and use of the Cough Stimulator. The actual costs of implantation are added to the costs of respiratory management in year 1. Total costs after year 1 were not significantly different compared to total costs pre implantation due to a significant reduction in the usual costs of respiratory management. Overall costs were significantly lower in years 2 and 3 during which subjects continued to use the Cough Stimulator (*p < .05 if compared to pre implant). See text for further explanation.