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Cost Benefit Analysis of Neurostimulation for Chronic Pain

Mekhail, Nagy A. MD, PhD; Aeschbach, Armin MD; Stanton-Hicks, Michael MD

Original Article

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.

From the Department of Pain Management, The Cleveland Clinic Foundation, Cleveland, OH.

Received March 18, 2003; revised July 4, 2003; accepted July 19, 2003.

Reprints: Nagy A. Mekhail, MD, PhD, Chairman, Department of Pain Management, The Cleveland Clinic Foundation, 9500 Euclid Avenue, C25, Cleveland, OH 44195 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.