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. 2024 May;18(3):635-643.
doi: 10.1177/19322968221128321. Epub 2022 Oct 31.

Healthcare Economics of High Frequency Spinal Cord Stimulation for Painful Diabetic Peripheral Neuropathy

Shashank Rajkumar  1 , Vishal Venkatraman  1 , Lexie Zidanyue Yang  2 , Beth Parente  1 , Hui-Jie Lee  2 , Shivanand P Lad  1
Affiliations

Healthcare Economics of High Frequency Spinal Cord Stimulation for Painful Diabetic Peripheral Neuropathy

Shashank Rajkumar et al. J Diabetes Sci Technol. 2024 May.

Abstract

Background: Painful diabetic peripheral neuropathy (pDPN) is a debilitating complication of long-term diabetes. High-frequency spinal cord stimulation (HF-SCS) was recently shown to be an effective treatment option, but the associated healthcare resource utilization (HCRU) on real-world patient populations with pDPN is unknown.

Methods: Using IBM MarketScan databases, we identified patients with HF-SCS implantation between January 2016 and December 2019 who had a diagnosis of diabetes or diabetic neuropathy within two years before implant. Cost data were collected for the six months before HF-SCS implantation (baseline) and for the periods of one, three, and six months post-implantation. The six-month explant rate was calculated.

Results: A total of 132 patients met inclusion criteria. The median total cost at baseline was $19 220 and was $1356 at one month post-implant, $4858 at three months post-implant, and $13 305 at six months post-implant. The median baseline out-of-pocket cost was $1477 and was $710 at six months post-implant. The average total cost reduction from baseline to six months post-implant was $5118 (P < .001), or $853 per month. The median device acquisition cost was $35 755. The explant rate within six months was 2.1%.

Conclusions: High frequency spinal cord stimulation significantly reduces total HCRU in patients with pDPN, and based on the average monthly cost reduction of $853, we estimate that the therapy recoups acquisition costs within 3.5 years. As policy increasingly focuses on value-based care, it will be critical to consider the cost and outcomes of innovative therapies.

Keywords: diabetic neuropathy; healthcare economics; healthcare resource utilization; spinal cord stimulation.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Lad is a consultant for Abbott Laboratories, Boston Scientific, Higgs Boson Health, Medtronic, Minnetronix, Nevro, and Presidio Medical.

Figures

Figure 1.
Figure 1.
Consort diagram outlining patient selection. Abbreviation: pDPN, painful diabetic peripheral neuropathy. HF10: High Frequency 10kHz Spinal Cord Stimulation; IPG: Implantable Pulse Generator; CRPS: Complex Regional Pain Syndrome.
Figure 2.
Figure 2.
Total cost incurred. Abbreviation: pDPN, painful diabetic peripheral neuropathy.
Figure 3.
Figure 3.
Out-of-pocket costs. Abbreviation: pDPN, painful diabetic peripheral neuropathy.
See this image and copyright information in PMC

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