Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment
Abstract Introduction This study evaluates the financial impact on healthcare payers when chronic pain patients initiate peripheral nerve stimulation (PNS) with a 60-day percutaneous PNS (60-Day PNS) treatment versus a conventional brief PNS trial (PNS-BT) with possible follow-on of a permanently im...
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| Format: | Article |
| Language: | English |
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Adis, Springer Healthcare
2024-11-01
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| Series: | Pain and Therapy |
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| Online Access: | https://doi.org/10.1007/s40122-024-00677-4 |
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| author | David M. Dickerson Hemant Kalia Kevin E. Vorenkamp Konstantin V. Slavin Jonathan M. Hagedorn Candace Gunnarsson Eric L. Keuffel Andrew J. Epstein Mark Stultz Nathan D. Crosby |
| author_facet | David M. Dickerson Hemant Kalia Kevin E. Vorenkamp Konstantin V. Slavin Jonathan M. Hagedorn Candace Gunnarsson Eric L. Keuffel Andrew J. Epstein Mark Stultz Nathan D. Crosby |
| author_sort | David M. Dickerson |
| collection | DOAJ |
| description | Abstract Introduction This study evaluates the financial impact on healthcare payers when chronic pain patients initiate peripheral nerve stimulation (PNS) with a 60-day percutaneous PNS (60-Day PNS) treatment versus a conventional brief PNS trial (PNS-BT) with possible follow-on of a permanently implanted PNS system (PNS-PI). Methods Centers for Medicare & Medicaid Services (CMS) fee-for-service (FFS) data were analyzed to identify patients with at least 12 months of follow-up (median 26.4 months) who initiated PNS treatment with: (1) 60-Day PNS or (2) PNS-BT. An economic decision tree model assessed the cost to payers in each cohort. Clinical response to 60-Day PNS was estimated by retrospectively reviewing anonymized outcomes from a national real-world database, focusing on patients ≥ 65 years of age who were implanted with a 60-day percutaneous PNS system. For the economic model, a Monte Carlo simulation with 10,000 iterations was used to generate 95% confidence intervals, considering variability in treatment outcome probability and costs. Results Based on CMS data, among 60-Day PNS patients, 18% (229/1265) proceeded to a permanently implanted PNS system with a 4% explant rate (10/229). Among PNS-BT patients, 41% (1140/2811) received a permanent implant with a 7% rate of explant (77/1140). Estimated PNS-related weighted average costs for the 60-Day PNS cohort [US$17,344; 95% confidence interval (CI): $16,168–$18,527] were lower than the PNS-BT cohort ($24,392; 95% CI $22,865–$25,941) when considering the percent of patients who advanced to a permanently implanted PNS system. The total cost per successful outcome also favored 60-Day PNS ($25,228 per success for the 60-Day PNS cohort vs. $64,502 per success for the PNS-BT cohort) as a first-line approach in PNS treatment. Conclusions The findings suggest that, when PNS for chronic pain is warranted, initiating PNS with a 60-day treatment is more cost-effective than utilizing a brief conventional trial. |
| format | Article |
| id | doaj-art-56f9e0dcb90641b9bdc0c1fe2c950304 |
| institution | Kabale University |
| issn | 2193-8237 2193-651X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Pain and Therapy |
| spelling | doaj-art-56f9e0dcb90641b9bdc0c1fe2c9503042025-01-26T12:14:01ZengAdis, Springer HealthcarePain and Therapy2193-82372193-651X2024-11-0114126928210.1007/s40122-024-00677-4Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS TreatmentDavid M. Dickerson0Hemant Kalia1Kevin E. Vorenkamp2Konstantin V. Slavin3Jonathan M. Hagedorn4Candace Gunnarsson5Eric L. Keuffel6Andrew J. Epstein7Mark Stultz8Nathan D. Crosby9Department of Anesthesiology, Critical Care, and Pain Medicine, Endeavor HealthCenter for Research and Innovation in Spine and Pain (C.R.I.S.P)Department of Anesthesiology, Duke UniversityDepartment of Neurosurgery, University of Illinois at ChicagoDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicGunnarsson ConsultingHealth Finance and Access InitiativeMedicus EconomicsSPR TherapeuticsSPR TherapeuticsAbstract Introduction This study evaluates the financial impact on healthcare payers when chronic pain patients initiate peripheral nerve stimulation (PNS) with a 60-day percutaneous PNS (60-Day PNS) treatment versus a conventional brief PNS trial (PNS-BT) with possible follow-on of a permanently implanted PNS system (PNS-PI). Methods Centers for Medicare & Medicaid Services (CMS) fee-for-service (FFS) data were analyzed to identify patients with at least 12 months of follow-up (median 26.4 months) who initiated PNS treatment with: (1) 60-Day PNS or (2) PNS-BT. An economic decision tree model assessed the cost to payers in each cohort. Clinical response to 60-Day PNS was estimated by retrospectively reviewing anonymized outcomes from a national real-world database, focusing on patients ≥ 65 years of age who were implanted with a 60-day percutaneous PNS system. For the economic model, a Monte Carlo simulation with 10,000 iterations was used to generate 95% confidence intervals, considering variability in treatment outcome probability and costs. Results Based on CMS data, among 60-Day PNS patients, 18% (229/1265) proceeded to a permanently implanted PNS system with a 4% explant rate (10/229). Among PNS-BT patients, 41% (1140/2811) received a permanent implant with a 7% rate of explant (77/1140). Estimated PNS-related weighted average costs for the 60-Day PNS cohort [US$17,344; 95% confidence interval (CI): $16,168–$18,527] were lower than the PNS-BT cohort ($24,392; 95% CI $22,865–$25,941) when considering the percent of patients who advanced to a permanently implanted PNS system. The total cost per successful outcome also favored 60-Day PNS ($25,228 per success for the 60-Day PNS cohort vs. $64,502 per success for the PNS-BT cohort) as a first-line approach in PNS treatment. Conclusions The findings suggest that, when PNS for chronic pain is warranted, initiating PNS with a 60-day treatment is more cost-effective than utilizing a brief conventional trial.https://doi.org/10.1007/s40122-024-00677-4Peripheral nerve stimulation (PNS)Health care costsChronic painNeuromodulation60-day PNSPercutaneous PNS |
| spellingShingle | David M. Dickerson Hemant Kalia Kevin E. Vorenkamp Konstantin V. Slavin Jonathan M. Hagedorn Candace Gunnarsson Eric L. Keuffel Andrew J. Epstein Mark Stultz Nathan D. Crosby Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment Pain and Therapy Peripheral nerve stimulation (PNS) Health care costs Chronic pain Neuromodulation 60-day PNS Percutaneous PNS |
| title | Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment |
| title_full | Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment |
| title_fullStr | Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment |
| title_full_unstemmed | Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment |
| title_short | Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment |
| title_sort | cost savings in chronic pain patients initiating peripheral nerve stimulation pns with a 60 day pns treatment |
| topic | Peripheral nerve stimulation (PNS) Health care costs Chronic pain Neuromodulation 60-day PNS Percutaneous PNS |
| url | https://doi.org/10.1007/s40122-024-00677-4 |
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