A Spinal Cord Stimulation Service Review From a Single Centre Using a Single Manufacturer Over a 7.5 Year Follow-Up Period

Thomson, Simon; Kruglov, Dmitry; Duarte, Rui

doi:10.1111/ner.12587

Cited by 29 publications

(23 citation statements)

References 12 publications

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“…A rate of 67% has been observed in an RCT of SCS for CRPS , while for FBSS, an RCT has reported a trial to implant ratio of 83% (considering the number of patients that achieved 50% or more leg pain relief or 80% paraesthesia coverage during the screening trial and not including those patients that requested to be implanted with a device despite failing the screening trial) . Recent service reviews conducted in the US and in the UK reported trial to implant ratios of 68% and 92% respectively . A trial to implant rate of 91% was observed in data from the Netherlands, and therefore similar to that observed in the UK .…”

Section: Discussionmentioning

confidence: 99%

“…Clinical diagnosis may also have an effect in the trial to implant ratios reported for SCS. The trial to implant ratios presented within this assessment were based on studies where the diagnosis was specific, i.e., CRPS only , FBSS only , or comprising patients with heterogeneous clinical diagnoses . RCTs evaluating SCS for painful diabetic neuropathy have reported trial to implant ratios of 77% and 92.5% .…”

Section: Discussionmentioning

confidence: 99%

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Trial Versus No Trial of Spinal Cord Stimulation for Chronic Neuropathic Pain: Cost Analysis in United Kingdom National Health Service

Duarte

Thomson

2019

Neuromodulation: Technology at the Neural Interface

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Objectives The aim of the current project was to evaluate the spinal cord stimulation (SCS) screening trial success rate threshold to obtain the same cost impact across two identical sets of patients following either a prolonged screening trial prior to implantation strategy or a full implant without a screening trial. Materials and Methods A cost impact analysis was carried out from a health care perspective and considered trial to implant rates reported in the literature. Items of resource use were costed using national averages obtained from the National Health Service (NHS) reference cost data base. Cost components were added up to derive total patient level costs for the NHS. Only the costs associated with the screening trial procedures and devices were considered. Results The most conservative of our estimates suggest that a failure rate of less than 15% is cost saving to the NHS. A failure rate as high as 45% can also be cost saving if the less expensive nonrechargeable SCS devices are used. All the thresholds observed represent a considerably higher screening failure rate than that reported in the latest randomized controlled trials (RCTs) of SCS. A trial to implant ratio of 91.6% could represent savings between £16,715 (upper bound 95% CI of rechargeable implantable pulse generator [IPG] cost) and £246,661 (lower bound 95% CI of nonrechargeable IPG cost) per each 100 patients by adopting an implantation only strategy. Conclusions Considerable savings could be obtained by adopting an implantation strategy without a screening trial. It is plausible that accounting for other factors, such as complications that can occur with a screening trial, additional savings could be achieved by choosing a straight to implant treatment strategy. Nevertheless, additional evidence is warranted to support this claim.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trial Versus No Trial of Spinal Cord Stimulation for Chronic Neuropathic Pain: Cost Analysis in United Kingdom National Health Service

Duarte

Thomson

2019

Neuromodulation: Technology at the Neural Interface

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“…To date, published SSI rates for SCS have ranged from 1 to 10% (1,(5)(6)(7)(8)(9)(10)(11). SSI incidence rates for implantable pain therapies have been gathered from data from retrospective and prospective studies, randomized controlled trials, and systematic reviews.…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Stimulation Infection Rate and Risk Factors: Results From a United States Payer Database

Falowski

Provenzano²,

Xia

et al. 2019

Neuromodulation: Technology at the Neural Interface

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Objective: Surgical site infections can cause negative clinical and economic outcomes. A recent international survey on Spinal Cord Stimulation (SCS) infection control practices demonstrated low compliance with evidence-based guidelines. This study defines infection rate for SCS implants and identifies infection risk factors. Results: In the logistic regression (n = 6615), 12 m device-related infection rate was 3.11%. Infection risk factors included peripheral vascular disease (OR, 1.784; 95% CI: 1.011-3.149; p = 0.0457) and infection in 12 m before implant (OR, 1.518; 95% CI: 1.022-2.254; p = 0.0386). The odds of patients experiencing an infection decreased by 3.2% with each additional year of age (OR, 0.968; 95% CI: 0.952-0.984; p < 0.0001). Survival analysis (n = 13,214) identified prior infection (HR, 1.770; 95% CI: 1.342-2.336; p < 0.0001) as a risk factor. Infection was less likely in older patients (HR, 0.974; 95% CI: 0.962-0.986; p < 0.0001). Expected risk factors including obesity, diabetes, and smoking were not identified as risk factors in this analysis. There was no significant difference between infection rate for initial and replacement implants.Conclusions: The 3.11% SCS-related infection rate within 12 m of implant emphasizes the need for improved infection control practices. Research is needed to limit SCS infections in younger patients and those with infection history.

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“…Greater than 50% of individuals that suffered a surgical site infection did not continue SCS therapy after the infection. Spinal cord stimulation has been demonstrated to be an efficacious treatment for many individuals suffering from neuropathic pain states . Once the device is removed, patient treatment options are often limited.…”

Section: Discussionmentioning

confidence: 99%

“…Infection has been identified as one of the most common complications of SCS, with clinical literature reporting a wide range of SCS device‐related infection rates . Clinical studies reported SCS device‐related infection rates ranging from 1% to 10% . A recent risk factor analysis looked at data from the Marketscan® health insurance claims database and found the infection rate to be 3.11% .…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database

Provenzano¹,

Falowski²,

Xia

et al. 2019

Neuromodulation: Technology at the Neural Interface

View full text Add to dashboard Cite

A Spinal Cord Stimulation Service Review From a Single Centre Using a Single Manufacturer Over a 7.5 Year Follow-Up Period

Cited by 29 publications

References 12 publications

Trial Versus No Trial of Spinal Cord Stimulation for Chronic Neuropathic Pain: Cost Analysis in United Kingdom National Health Service

Trial Versus No Trial of Spinal Cord Stimulation for Chronic Neuropathic Pain: Cost Analysis in United Kingdom National Health Service

Spinal Cord Stimulation Infection Rate and Risk Factors: Results From a United States Payer Database

Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database

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