Statewide Success of Staged Sacral Neuromodulation for the Treatment of Urinary Complaints in California (2005–2011)

Self Cite

Aims Sacral neuromodulation (SNM) is a standard therapy for refractory overactive bladder (OAB). Traditionally, SNM placement involves placement of an S3 lead with 1–3 weeks of testing before considering a permanent implant. Given the potential risk of bacterial contamination during testing and high success rates published by some experts, we compared the costs of traditional 2‐stage against single‐stage SNM placement for OAB. Methods We performed a cost minimization analysis using published data on 2‐stage SNM success rates, SNM infection rates, and direct reimbursements from Medicare for 2017. We compared the costs associated with a 2‐stage vs single‐stage approach. We performed sensitivity analyses of the primary variables listed above to assess where threshold values occurred and used separate models for freestanding ambulatory surgery centers (ASC) and outpatient hospital departments (OHD). Results Based on published literature, our base case assumed a 69% SNM success rate, a 5% 2‐stage approach infection rate, a 1.7% single‐stage approach infection rate, and removal of 50% of non‐working single‐stage SNMs. In both ASC ($17 613 vs $18 194) and OHD ($19 832 vs $21 181) settings, single‐stage SNM placement was less costly than 2‐stage placement. The minimum SNM success rates to achieve savings with a single‐stage approach occur at 65.4% and 61.3% for ASC and OHD, respectively. Conclusions Using Medicare reimbursement, single‐stage SNM placement is likely to be less costly than 2‐stage placement for most practitioners. The savings are tied to SNM success rates and reimbursement rates, with reduced costs up to $5014 per case in centers of excellence (≥ 90% success).

Section: Discussionmentioning

confidence: 57%

“…As Medicare is the most common payor for SNM placement, we based our primary model on their costs and methods for reimbursements. However, not all payors reimburse equally.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

To stage or not to stage?—A cost minimization analysis of sacral neuromodulation placement strategies

Sun

Harris

Comiter

et al. 2019

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“…SNS using the commercially available system is prescribed for the treatment of OAB in patients that have failed or could not tolerate more conservative treatments. Test stimulation is associated with success rates approximating 70% followed by a success rates more than 80% after IPG implantation . However, the benefits of the commercially available system come with a set of drawbacks.…”

Section: Resultsmentioning

confidence: 99%

First‐in‐human implantation of a mid‐field powered neurostimulator at the sacral nerve: Results from an acute study

Kerrebroeck

Reekmans

Koeveringe

et al. 2019

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Introduction Commercially approved implantable systems for sacral neuromodulation require the implantation of a multipolar lead subcutaneously connected to an implantable pulse generator (IPG). Eliminating the need for an IPG would eliminate the need for tunneling of the lead, reduce procedure time, infection risk, and the need for IPG replacement. The objective was to demonstrate the feasibility of implanting the AHLeveeS System in the S3 Foramen to stimulate the S3 sacral nerve. Materials and Methods A first‐in‐human, prospective, single center, nonrandomized, acute feasibility clinical investigation at the Maastricht University Medical Center+. Patients with refractory overactive bladder underwent acute implantation of the AHLeveeS neurostimulator before the InterStim procedure. Outcome measurements included motor responses, procedural time and a scoring of the difficulty of the implant and explant procedure. Retrospectively, qualitative responses to the stimulation protocol were assessed by video motion analyses. Only descriptive statistics were used. Results During the stimulation a motor response to stimulation was seen in four of the five subjects. In all implantations the AHLeveeS was correctly placed. The median time for complete procedure was 24 minutes. The implant and explant procedures were successfully performed and no device or procedure related adverse events occurred. Conclusions The results from this acute first‐in‐human study demonstrate the feasibility of implantation and acute stimulation of the sacral nerve with this mid‐field powered system. Future clinical studies will focus on safety and efficacy of a chronically implanted device.

Improving clinical outcomes with lower motor voltage (≤3 V) during stage 1 sacral neuromodulation for interstitial cystitis or bladder pain syndrome

Marinkovic

2019

Aims We desire to evaluate whether utilization of ≤3 V (new experimental approach) vs the traditional four or more volts for lead motor response during stage 1 sacral neuromodulation may impart an improvement in voiding and pain parameters. Methods An observational, retrospective, double cohort review was conducted of 179 female patients who experienced medically recalcitrant interstitial cystitis (IC) or bladder pain syndrome (BPS) between January 2002 and January 2013. Group A included 105 women with a motor response of ≤3 V; group B was comprised of 65 women with a motor response at ≥4 V for medically recalcitrant IC or BPS. Patients completed a 3‐day pre‐ and postoperative voiding diary, visual analog pain (VAP) scale, pain urgency frequency (PUF), and Patient Global Impression of Improvement (PGI‐I) questionnaire. Results The mean (standard deviation) follow‐up in months was 120.1 ± 33.3 in group A and 116.3 ± 29.2 in group B (P < .45). A successful conversion from stage 1 to stage 2 showed statistically significant improvement for group A compared with group B (95.4% vs 73.8% conversion rate; P < .001). The success rate also favored group A, with 87.6% success compared with 66.2% for group B (P < .002). Group A mean postoperative VAP scores improved over group B with 3.3 ± 1.2 compared with 5.0 ± 0.8 (P < .001). Group A mean postoperative PUF scores were 10.2 ± 2.7 and group B 14.7 ± 3.5, (P < .001). Conclusions In the ≤3 V patient cohort, a compelling, significant statistical improvement was noted in most clinical voiding parameters, including the VAP, PGI‐I, and performance questionnaires.