Actual Cost of Spinal Cord Stimulation for Chronic Pain

For over 30 years now, doctors have used spinal cord stimulation (SCS), also called neurostimulation, to help relieve chronic neuropathic (nerve) pain. A stimulator is implanted into the patient's body, which then sends out impulses to interrupt the pain signals and prevent them from reaching the brain.

The treatment doesn't eliminate pain. The electrical impulses from the stimulator override the pain messages so the person doesn't feel the pain so acutely or so intensely. In essence, the stimulator masks the pain. SCS is generally only used if nothing else in treatment seems to be working. It must be done on a trial basis first before the stimulator is permanently implanted.

The success of this treatment has increased its use for chronic pain patients in the United States and Canada. But before we go too far with this treatment tool, it's important to look at the total cost (not just the initial implantation cost). Third party payers such as private insurance, Blue Cross/Blue Shield (health maintenance plan), and Medicare have asked physicians to show that the benefit of this treatment is worth the cost.

That's a reasonable request considering the basic cost of the unit and implantation ranges from $21,595 to $57,800 (depending on who is paying for it). That figure does include the preoperative evaluation and the trial before permanent implantation. But what this study shows for the first time are the added costs of maintenance, upkeep, and complications.

The cost of uncomplicated annual care to maintain the system starts at $3500 in Canada, goes to $5000 under Medicare, and tops at $7277 for Blue Cross/Blue Shield patients. Each time a new patient receives a spinal cord stimulator, the total cost for actively managed patients is increased.

The annual maintenance costs cover things like hardware, professional fees (doctors, nurses), X-rays or other advanced imaging studies, pulse generator replacement, and any costs associated with hospitalization for complications. That doesn't include the cost of medications used for drug therapy. Different complications have different average costs associated with them. Obviously replacing the batteries is much less costly than a hospitalization for infection or implant failure.

These costs do not reflect out-of-pocket money spent by patients pursuing this type of treatment. Since spinal cord stimulation is not readily available at every hospital, it is necessary for some patients to travel far distances to benefit from this specialized pain control. Travel costs, lodging, and meals are not included in these figures.

The are some things that can be done to bring the costs down. One is to develop a rechargeable system that lasts for more than a few years. Some companies manufacturing these devices are already promising a battery life of 10 to 25 years. The second is to recognize that different manufacturers charge different selling prices to different geographical markets. And the third is to study which models function without breaking down and use those instead of poorly designed, short-lasting units.

The authors present a formula that can be used when first calculating the cost of a spinal cord implant. A second equation calculates the add-on costs of annual maintenance and complications. It turns out that the added costs amount to about 18 per cent of the initial implantation cost. Health care centers can use this information when planning budgets and cost-versus-benefit ratios.

Krishna Kumar, MB, MS, FRCSC, and Sharon Bishop, BNurs, MHlthSci. Financial Impact of Spinal Cord Stimulation on the Healthcare Budget: A Comparative Analysis of Costs in Canada and the United States. In Journal of Neurosurgery: Spine. June 2009. Vol. 10. No. 6. Pp. 564-573.



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