Cost benefit analysis of neurostimulation for chronic pain
Cost benefit analysis of neurostimulation for chronic pain
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DOI：
10.1097/00002508-200411000-00012
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发表时间：
2004-11-01
影响因子：
2.9
通讯作者：
Stanton-Hicks, M
中科院分区：
文献类型：
--
作者：
Mekhail, NA;Aeschbach, A;Stanton-Hicks, M
目的：评价脊髓刺激和周围神经刺激治疗顽固性慢性神经性疼痛患者的医疗利用情况，并进行成本-效益分析。方法：对1990年至1998年在克利夫兰临床基金会接受脊髓刺激或周围神经刺激植入术的222例患者进行回顾性分析。患者被要求完成一份神经刺激结果问卷，旨在收集从手术植入前一年开始的医疗资源利用数据。这些数据被汇集在一起，计算出装置植入前后每个患者每年发生的事件的净差值，并根据从联邦医疗保险费用表和医疗保健融资管理获得的2000年成本数据进行建模。结果：128名患者收回了神经刺激结果问卷。患者年龄21~71年，平均46±12.5岁；种植时间0.5~8.9年，平均3.1±2.3年。在没有药物治疗的情况下，每个患者的脊髓刺激/周围神经刺激的平均总报销为38187美元。接受脊髓刺激/周围神经刺激止痛治疗的患者减少了医生办公室就诊、神经阻滞、放射成像、急诊科就诊、住院和手术程序，这意味着在3.1年的植入期间，每年净节省约30,221美元，节省93,685美元。脊髓刺激/周围神经刺激植入后医疗利用率的大幅下降导致每个患者每年净节省约17,903美元的成本。讨论：接受神经刺激的患者对医疗资源的需求减少表明，尽管周围神经刺激和脊髓刺激治疗的初始成本相对较高，但显示出可观的长期经济效益。因此，神经刺激应该被认为是顽固性慢性神经病理性疼痛患者早期治疗的一个可行的选择。
Objectives: To assess the healthcare utilization of patients with intractable chronic neuropathic pain treated with spinal cord stimulation and peripheral nerve stimulation and to provide a cost-benefit analysis.Methods: The case records of 222 consecutive patients who received spinal cord stimulation or peripheral nerve stimulation implants at the Cleveland Clinic Foundation between 1990 and 1998 were reviewed retrospectively. Patients were asked to complete a Neurostimulation Outcome Questionnaire designed to gather data on utilization of healthcare resources starting 1 year before surgical implantation. These data were pooled and net differences in events per patient per year, before and after device implantation were calculated and modeled to 2000 cost data obtained from the Medicare Fee Schedule and Healthcare Financing Administration.Results: Neurostimulation Outcome Questionnaires were returned by 128 patients. The mean patient age was 46 +/- 12.5 years (range 21-71 years) and the mean implant duration was 3.1 +/- 2.3 years (range 0.5-8.9 years). The mean per patient total reimbursement of spinal cord stimulation/peripheral nerve stimulation absent pharmacotherapy was $38,187. Patients treated with spinal cord stimulation/peripheral nerve stimulation for pain management achieved reductions in physician office visits, nerve blocks, radiologic imaging, emergency department visits, hospitalizations, and surgical procedures, which translated into a net annual savings of approximately $30,221 and a savings of $93,685 over the 3.1-year implant duration. The large reduction in healthcare utilization following spinal cord stimulation/peripheral nerve stimulation implantation resulted in a net per patient per year cost savings of approximately $17,903.Discussion: The reduced demand for healthcare resources by patients receiving neurostimulation suggests that peripheral nerve stimulation and spinal cord stimulation treatment, although associated with relatively high initial costs, demonstrates substantial long-term economic benefits. Thus, neurostimulation should be considered as a viable option for the early treatment of patients with intractable chronic neuropathic pain.