Spinal Cord Stimulation Reduces Pain-related Healthcare Utilization: A Real-world Data Analysis

Introduction: It is well established that spinal cord stimulation (SCS) improves subjective pain-related measures among chronic pain patients.1 However, conflicting reports have been published on the impact of SCS on healthcare utilization (HCU) and its associated healthcare costs.2,3,4 We utilized data from 16,846 patients to demonstrate a significant and sustained reduction in annual pain-related HCU following Abbott SCS implant.

Methods: De novo Abbott SCS patients were identified in the Medicare Fee-for-service database via linkage to the Abbott patient database. Indication for SCS implant was determined using the index implant claim and claims during the 12 months preceding the SCS implant. Patients were censored if they switched to Part C, died, underwent simultaneous IPG and lead removal without Abbott replacement within 30 days, or underwent neurostimulator or intrathecal pump implant. Pain-related HCU was defined as the number of healthcare visits with an indication-related primary diagnosis code during the baseline (12 months before the SCS implant) and the follow-up (12-month increments post SCS implant) period. Patients having at least 12 months of Medicare Part A and B data pre-implant and remaining uncensored during follow-up were retained for each follow-up period. Two distinct methods were utilized to validate the results. Atrial fibrillation and chronic kidney disease during the baseline and follow-up period were used as falsification endpoints. Negative control analysis was used to compare pain-related HCU between 24-12 months pre-implant, 12 months pre-implant to implant, and implant-12 months post-implant among patients with available data.

Results: A total of 16,846 patients were included in the analysis. The mean number of visits decreased significantly from baseline across all follow-up periods: 7.2 in the baseline to 2.9 in the follow-up period (60.1% reduction), with a reduction ranging from 68% to 75% in the following years. Among 2,439 patients with at least 5 years of follow-up, the mean number of pain-related healthcare visits reduced significantly from 7.5 at baseline to 1.9 (74.9% reduction). In contrast, falsification endpoints exhibited minimal changes during the first year of follow-up. Negative control analysis included 8,269 patients. The mean number of visits increased from ~7 to ~10 between 24-12 months pre-implant but decreased to ~4 post-implant, reinforcing the observed post-treatment effect.

Conclusion: In this large, real-world data-based study, Abbott SCS devices demonstrated a significant and sustained reduction in pain-related HCU for multiple years following implant. Sensitivity analyses highlight the utility of this methodology, being specific to chronic pain and a strong association between an SCS implant and a reduction in pain-related HCU.