Economic Consequences of an Implanted Neuroprosthesis in Subjects with Spinal Cord Injury for Restoration of an Effective Cough

Abstract

To determine if an implanted neuroprosthesis for restoration of an effective cough is less costly than conventional methods of respiratory management. Nonrandomized clinical trial of participants ( = 14) with spinal cord injury (SCI) using the Cough Stimulator device in the inpatient hospital setting for Cough Stimulator implantation and outpatient hospital or residence for follow-up. A neuroprosthesis was implanted for restoration of an effective cough. The annual costs associated with respiratory management, without (pre implantation) and with (post implantation) the neuroprosthesis, were examined over a 4-year period. The total cost related to implantation of the Cough Stimulator was $59,891, with no maintenance costs over subsequent years. The incidence of respiratory tract infections and the need for caregiver support fell significantly following implantation. The costs associated with respiratory tract infections fell significantly from a mean of $36,406 ± 11,855/year to $13,284 ± 7,035/year ( < .05) pre and post implantation, respectively. Costs fell further to $8,817 ± 5,990 and $4,467 ± 4,404 following the 2nd and 3rd years post implantation ( < .05), respectively. The costs associated with caregiver support fell significantly from $25,312 ± 8,019/year to $2,630 ± 2,233/year ( < .05) pre and post implantation, respectively, and remained low in subsequent years ( < .05). Other costs related to secretion management fell significantly and remained low in subsequent years ( < .05). Break-even analysis demonstrated that this point was reached in the first year. The results of this investigation demonstrate that implantation and use of the Cough Stimulator resulted in significant reductions in the overall costs of respiratory management in this patient population.

Case Report: Effects of Lower Thoracic Spinal Cord Stimulation on Bowel Management in a Person with Spinal Cord Injury

“…Interestingly, the subject of this case report did not report incontinence as a concern either before institution of SCS nor afterwards. Moreover, in our previous case series, none of our persons participating in the study of SCS to restore cough reported fecal incontinence associated with SCS [3][4][5][6][7][8][9].…”

“…O p e n H U B f o r S c i e n t i f i c R e s e a r c h this subject approached 200 cmH 2 O when performed at TLC [3][4][5][6][7][8][9]. Restoration of the ability to generate large intra-abdominal pressures by use of SCS therefore, likely played an important role in the improvements in bowel function observed by this subject.…”

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In an on-going clinical trial to restore an effective cough in tetraplegic individuals, spinal cord stimulation (SCS) is applied over the dorsal lower thoracic spinal cord. SCS results in marked contraction of the expiratory muscles which include the abdominal muscles, resulting in the generation of very large intra-abdominal pressures and restoration of an effective cough [3][4][5][6][7][8][9].Over the course of this study, several persons volunteered that they became aware of an improvement in their bowel routines as a beneficial side effect consequent to the use of SCS. For this reason, we altered our clinical protocol to address BM before and after the

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Case report: Minimally invasive method to activate the expiratory muscles to restore cough

“…In a recent cost analysis of the cough system using disc electrodes, we found that the break-even point was achieved within the first year due to the reduction in overall costs of respiratory care. 19 Since placement of wire electrodes can be placed utilizing less surgical time and on an out-patient basis, cost savings with this method could exceed $10,000 resulting in a break-even point well within the first year of use.…”