Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment.

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY

Pain and Therapy Pub Date : 2024-11-26 DOI:10.1007/s40122-024-00677-4

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

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引用次数: 0

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.

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慢性疼痛患者接受外周神经刺激 (PNS) 60 天治疗可节省的费用。

导言：本研究评估了慢性疼痛患者开始外周神经刺激（PNS）治疗时，60 天经皮 PNS（60-Day PNS）治疗与传统的短暂 PNS 试验（PNS-BT）以及可能的后续永久植入 PNS 系统（PNS-PI）治疗对医疗支付方的财务影响：对美国医疗保险与医疗补助服务中心（CMS）的付费服务（FFS）数据进行了分析，以确定至少随访 12 个月（中位数为 26.4 个月）、开始接受 PNS 治疗的患者：(1) 60 天 PNS 或 (2) PNS-BT。经济决策树模型评估了每个队列中支付者的成本。对 60 天 PNS 的临床反应是通过回顾性审查全国真实世界数据库中的匿名结果估算出来的，重点是年龄≥ 65 岁、植入了 60 天经皮 PNS 系统的患者。在经济模型中，考虑到治疗结果概率和成本的可变性，使用蒙特卡洛模拟法进行了 10,000 次迭代，以生成 95% 的置信区间：根据 CMS 数据，在 60 天 PNS 患者中，18%（229/1265）继续使用永久植入式 PNS 系统，爆炸率为 4%（10/229）。在 PNS-BT 患者中，41%（1140/2811）的患者接受了永久性植入，拆卸率为 7%（77/1140）。如果考虑到进展到永久植入 PNS 系统的患者比例，60 天 PNS 组群的 PNS 相关加权平均成本估计值 [17,344 美元；95% 置信区间 (CI)：16,168-18,527 美元] 低于 PNS-BT 组群（24,392 美元；95% CI：22,865-25,941 美元）。作为 PNS 治疗的一线方法，每次成功治疗的总成本也更倾向于 60 天 PNS（60 天 PNS 组别每次成功治疗的成本为 25,228 美元，PNS-BT 组别每次成功治疗的成本为 64,502 美元）：结论：研究结果表明，当需要对慢性疼痛进行 PNS 治疗时，采用 60 天治疗启动 PNS 比使用简短的常规试验更具成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pain and Therapy CLINICAL NEUROLOGY-

CiteScore

6.60

自引率

5.00%

发文量

110

审稿时长

6 weeks

期刊介绍： Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.