Oral Presentation Sydney Spinal Symposium 2025

Keynote Speaker - Spinal Cord Stimulators: Patterns Of Care, Reintervention Rate, And Cost Per Admission Using Australian Private Health Insurer Data (122835)

Caitlin MP Jones 1 , Christopher G Maher 1 , Rachelle Buchbinder 2 , Ian Harris 3 , Christine Lin 1 , Chris Hayes 4 , Alexandra Gorelik 2
  1. Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Camperdown, NSW, Australia
  2. Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  3. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
  4. Hunter Integrated Pain Service, Hunter New England Local Health District, University of Newcastle, Newcastle, NSW, Australia

Background: Spinal cord stimulators are promoted as a treatment for chronic back pain. They are increasingly used despite evidence against their efficacy and concerning data emerging about their harms. In Australia, 90% of spinal cord stimulators are implanted within the private healthcare system. Therefore, the records of private health insurers are a good source of information. We investigated patterns of care, reintervention rate, and costs to Australian private insurers.

Methods: We analyzed the data from patients using 5 Australian private health insurers (with 76% market share) who received spinal cord stimulation to treat pain between 2011 and 2022. Main outcomes were patterns of care, rate of surgical reintervention (e.g replacing hardware), and cost to insurer over entire episode of care.

Results: We received the records of 11,451 admissions for 5,839 unique patients. Most people had one trial first, followed by a definitive implant, however there was substantial variation in the patterns of care (e.g. multiple trials, using the more expensive definitive leads for trial procedures, etc). Twenty-three percent of patients who had a definitive generator implanted had at least one reintervention within three years. The median cost to the insurer for an episode of care (including all related reinterventions, excluding gap charges paid by the patient) was $13,700 AUD for a trial only and $55,600 AUD for a definitive implant per patient over a median period of 48 months. We also noted large variation in costs, with the range of total costs per episode of care spanning over $500,000 for a definitive implant and over $100,000 for a trial.

Conclusions: Spinal cord stimulators are highly likely to require reinterventions well before expected (such as planned battery changes) and they are expensive. Given that there is evidence against their efficacy in treating pain, their use should be reconsidered.