POSB296 Cost Efficiencies for Spinal Cord Stimulation in Denmark: Impact of Battery Longevity for Non-Rechargeable Devices and a 1-Stage Approach

Abstract

Spinal cord stimulation (SCS) is a treatment for chronic intractable pain, with non-rechargeable (NR) devices a choice for patients who prefer a recharge-free option. Whilst SCS is a 2-stage procedure with a trial phase followed by permanent device implantation, a 1-stage approach can be used with equivalent safety and clinical outcomes. This analysis explores the costs of both approaches, incorporating battery longevity improvements amongst newer devices in Denmark (2021). Since 2019, three leading NR SCS devices have been launched: Device A (2019); Device B (2020); Device C (2021). Battery longevity of Devices A and B were obtained from product manuals. Longevity of the newest Device C was estimated at comparable stimulation settings for Device A (4.5 years vs. 8.31 for Device C) and Device B (5.1 years vs. 9.27 for Device C). A Markov model simulated individual patients across four scenarios: A vs. C and B vs. C with both a 2-stage and 1-stage approach. A cycle length of one month and a 15-year time horizon was used, with a Danish national payer perspective. Registry data informed withdrawal and adverse event probabilities. Unit costs were taken from national DRGs. Using a standard 2-stage SCS approach, undiscounted total per-patient costs for Device A vs. Device C were DKK 1,153,794 and DKK 863,493, respectively; for Devices B vs. Device C were DKK 1,039,492 and DKK 847,696, respectively. Employing a 1-stage approach saved DKK 237,420 in all scenarios. The cost savings driver was fewer expected device replacements afforded by increased battery longevity of the newest device. Increases in SCS battery longevity can translate into cost savings for healthcare payers, which can be extended by employing a 1-stage approach. Understanding the potential cost benefit of device choice and procedural optimisation may inform budgetary decisions for long-term cost management of SCS.