Effectiveness of Electrical Neuromodulation: An Economic Paradigm

Abstract

The last 10–15 years has witnessed a rapid growth and advancement of electrical neuromodulation technologies: spinal cord stimulation, peripheral nerve stimulation, deep brain stimulation, and motor cortex stimulation. As the manuscripts in this Pain Medicine supplement attest, there is strong evidence documenting the efficacy and safety of electrical neuromodulation in the treatment of many chronic, refractory pain conditions, including complex regional pain syndromes, intractable angina pectoris, neuropathic extremity pain, axial low back pain, atypical facial pain, certain visceral pain syndromes, and others. Along with the growth in utilization of electrical neuromodulation therapies, competitive pressures within the healthcare industry have created the need for other healthcare decision makers, specifically the government and third-party insurance payers, to examine the overall effectiveness and costs of electrical neuromodulation. Our objective was not to summarize the results of cost analysis studies involving neuromodulation. Doing so would be relatively simple. It is more important for the clinician to understand the underlying problems in our current reimbursement system. In doing so, we as physicians can better understand the true “value” of electrical neuromodulation therapy from the perspectives of the individual patient, the hospital administrator, and the healthcare payer.