Healthcare Resource Utilization in Spinal Cord Stimulation Trial vs. Implant Patients: A Five-year Analysis

Introduction: Spinal Cord Stimulation (SCS) is a cost-effective therapy for chronic pain. This study refines earlier research by comparing patients who underwent only an SCS trial (SCS-T) with those who progressed to permanent implantation (SCS-I). SCS-T patients are a better comparator than prior studies use of conservative medical management (CMM) retrospective controls due to the ability to ensure patients were at a similar point in disease progression and pain severity. Prior retrospective studies comparing SCS with CMM were limited by comparison of statistically similar, but clinically heterogeneous cohorts.

Methods: Using Medicare Research Identifiable File claims data (2016–2024), patients with an SCS trial in 2018–2019 were identified. Those who received an implant within 180 days formed the treatment group (SCS-I), while those who did not were the control group (SCS-T). The average trial-to-implant interval was used to assign an index date to SCS-T patients. A two-year baseline captured demographics, clinical history, and medication use, followed by a five-year follow-up period. Propensity Score Matching ensured comparable cohorts. Outcomes were analyzed using Generalized Linear Models and chi-square tests. All patients had continuous enrollment from baseline through follow-up or death. Our main analysis consisted of the intent-to-treat (ITT) group of all patients meeting inclusion criteria. A secondary “as-treated” analysis was performed among patients with no explant procedure over follow-up (with their matched SCS-T patients also removed).

Results: A total of 14,274 patients were matched 1:1. Over the follow-up period, average annual total costs were similar for SCS-I compared to SCS-T ($25,788 vs. $25,786 respectively; P=0.996). SCS-I patients had significantly reduced inpatient costs ($5,584 vs. $6,309; P=0.017) and slightly higher outpatient costs ($3,253 vs. $3,043; P=0.020). After excluding 978 patients who underwent explant during follow-up and their matched controls (as-treated group), the average per-patient per-year costs over five years were significantly lower (-$1,184) for SCS-I vs SCS-T ($24,623 vs $25,807, P=0.003), driven by significantly lower inpatient costs. SCS-I patients had a 2.7–4.0% lower mortality during follow-up (P < 0.001).

Conclusion: Over five years, patients with a permanent SCS implant had significantly lower inpatient costs relative to patients that had only an SCS trial in the ITT group. When examining the as-treated group, the average per-patient per-year total cost was lower in the SCS-I group vs. SCS-T group. These findings support SCS as a long-term, cost-saving alternative to continued CMM or other treatments. These findings also highlight SCS’s potential in improving health outcomes and overall mortality.