MP75-05 NATIONAL TRENDS IN THE USAGE OF SACRAL NERVE STIMULATION AMONG MEDICARE BENEFICIARIES

Abstract

INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) (InterStim , Medtronic, Inc., Minneapolis, MN) has been used as a second-line therapy for both urinary and bowel control. There is limited data in the literature regarding trends of utilization of SNS to explore precisely who is treated with SNS. We sought to explore disparities in the utilization of SNS among Medicare beneficiaries. METHODS: A 5% national random sample of all Medicare claims for 2001, 2004, 2007, and 2010 was queried to identify patients of interest. All patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code that was a potential indication for SNS system were included. Patients who underwent SNS implantation were identified with Current Procedure Terminology (CPT-4) codes. Statistical tests used included the c2 and Fisher tests, as well as multivariate logistic regression analyses using SAS v9.3 (SAS Institute Inc., Cary, NC) and SPSS v20 (IBM Corp., Armonk, NY). RESULTS: A total of 3,198,300 patients were identified with a diagnosis that could potentially be treated with SNS. Of these patients, 14,780 patients underwent treatment with SNS (0.46%). The percentage of patients diagnosed who ultimately underwent treatment increased from 0.02% to 0.75% (p <0.001) over the 10-year study period. On logistic regression analysis, women (OR1⁄44.60, p<0.0001) and patients aged less than 65 years (OR1⁄41.00, compared to older age groups OR1⁄40.29-0.44, p<0.0001) were more likely to be treated with SNS. Non-white individuals (OR1⁄40.48, p<0.0001) and those living in the western U.S. (OR1⁄40.55, p<0.0001) were less likely to receive surgical treatment (see Table). CONCLUSIONS: The usage of SNS among patients diagnosed with a potential indication has significantly increased among Medicare beneficiaries over a 10-year period. Patients were more likely to be treated with SNS if they were female, white, were <65 years of age, and lived outside of the west coast of the U.S. Knowledge of these data might promote more equal access to SNS nationwide.