Spinal cord stimulation patterns of care, re-interventions, and costs for private health insurers, Australia, 2011-22: a retrospective observational study.

Abstract

To investigate spinal cord stimulation patterns of care, the proportions of people who require unplanned surgical interventions after receiving definitive spinal cord stimulator implants, and the costs to private health insurers in Australia. Retrospective observational study; analysis of deidentified private health care insurers benefits payments data. People admitted to hospital for spinal cord stimulation-related surgical procedures, 11 January 2011 - 13 April 2022, with full or partial costs coverage by five general private health care insurers. Patterns of care; proportions of people with stimulator implants who subsequently require surgical re-intervention, overall and within 36 months of receiving definitive implants; costs to insurer for trial, definitive implantation, and re-interventions. We analysed data for 11 451 admissions of 5839 people; mean age at first admission was 60.2 years (standard deviation, 15.4 years), 3717 people were women (63.7%). Median follow-up time was 48 months (interquartile range [IQR], 33-72 months). Definitive stimulators were implanted in 4361 people (74.7%), of whom 3244 had previously had at least one stimulation trial (74.3%; one trial only: 2970 people); 1478 people (25.3%) had trials but never proceeded to definitive implants. Surgical re-interventions were required by 1011 people with definitive implants (23.2%); the median time to the first re-intervention was 16.8 months (IQR, 6.2-39.8 months). The cumulative probability of requiring surgical re-intervention at 36 months was 0.35. The median cost to the insurer of a trial implant was $13 689, for a definitive implant (device, medical, and hospital costs for initial procedure and re-interventions) $55 635. About one in four people will require surgical re-intervention within 36 months of receiving a definitive spinal cord stimulator, and the costs for the procedure are high. Both findings are concerning given the paucity of evidence for their efficacy in treating chronic pain.