Implantable Pulse Generators in Spinal Cord Stimulation Therapy: The Burden of Costs of Complications Compared to Wireless Technology - Abstract
Background: Spinal cord stimulation (SCS) has been a time tested and cost-effective treatment to manage intractable chronic pain syndromes following spinal surgery, peripheral neuropathy, complex regional pain syndromes and others. However, the surgically implantable nature of all the components of SCS not only increases the surgical complications but the costs associated with the device also. Recent advancements in wireless technology appear to reduce these collateral burdens since the wireless device does not require an implantable pulse generator (IPG) or its connection cables.
Material and results: A review of the available literature on traditional SCS (TSCS) and costs incurred, revealed that cost of a nonrechargeable battery was USD 13,150 (CSD 10,591; UK £ 7,243) in 2006 while a rechargeable battery had cost USD 20,858. Maintenance costs for the SCS equipment included a battery change every 4 years, on an average costing USD 3,539. IPG replacement involved expenses of CAD 5.071. A wireless device (Stimwave) is devoid of IPG costs and required 3-year maintenance costs of 1500 Euros only.
Additionally, the wireless SCS (WSCS) is effective and without the complications of IPG which include pocket area pain, hematoma (in nearly 10% patients) and infection that accounts for 50% of infections following SCS implantation. Bench data had shown that a gluteal IPG location could produce nearly 9 cm of a thoracic lead displacement following spine motion in flexion, extension and rotation. Management of IPG complications costs additional health care budget, while with wireless SCS, this could be an avoidable expenditure. WSCS has been reported to be as effective as TSCS in patients with chronic pain following back surgery, herpes infection and complex regional pain syndrome in case illustrations.
Conclusions: SCS has been an effective tool in chronic pain management. Traditional equipment includes an IPG cost between 13,000 and 20,000USD with a maintenance expense of 3,539 USD over 4 years (for battery change). On the other hand, wireless SCS had been reported to have nearly half of this maintenance cost for SCS therapy and without IPG costs and complications. Further clinical studies might indicate IPG expenditure as a redundant and unnecessary cost.