Rechargeable spinal cord stimulation versus nonrechargeable system for patients with failed back surgery syndrome: A cost-consequences analysis

Objectives: Spinal cord stimulation (SCS) has been used for almost 40 years to treat refractory neuropathic pain after failed back surgery. Fully implantable nonrechargeable pulse generators have a battery life of between 2 and 5 years. A new SCS system with a rechargeable power source may last 10 to 25 years, or longer. The potential economic implications of longer battery life with a new SCS system has yet to be assessed. The study objective is to estimate the average difference in lifetime costs between rechargeable and nonrechargeable pulse generators used in treatment with SCS for failed back surgery syndrome. Methods: A generalized state-transition probability framework was used to model costs. Input parameters for the base case analysis were obtained from several data sources including published literature, Medicare fee schedules, Medicare claims data, and expert opinion. Results: A rechargeable SCS system is projected to require from 2.6 to 4.2 fewer battery generator replacements for battery depletion than a nonrechargeable SCS system. The total lifetime savings of a rechargeable system range from $104,000 to $168,833. In all of the one-way sensitivity analyses conducted, a rechargeable system saves money. Among all of the assumptions underlying the analysis, the annual cost after device removal contributes the most uncertainty. Conclusions: A rechargeable SCS system is projected to save up to $100,000 over a patient's lifetime. Fewer pulse generator replacements will also decrease patient discomfort and morbidity from procedural complications.