RESUMO
Background: Spinal cord stimulation (SCS) is a treatment for chronic intractable pain powered by an implantable pulse generator that may be rechargeable or not rechargeable (NR). It is performed in 2 stages (a trialing phase followed by permanent device implantation) and necessitates 2 hospitalizations, which may increase infection risk. Objective: This analysis explores the cost impact of improvements in battery longevity and the adoption of 1-step (direct-to-implant [DTI]) SCS implantation. Methods: Since 2019, 3 leading NR-SCS devices have been launched: Device A (2019), Device B (2020), and Device C (2021). The battery longevity of the newest Device C was estimated at comparable stimulation settings for Devices A and B. A Markov model simulated individual patient pathways across 2 scenarios: Device A vs Device C and Device B vs Device C (both with the DTI approach and 2-step approach). Costs considered were the initial device implantation procedure, device replacements, and serious adverse event (SAE) management. Italian diagnosis-related group (DRG) tariffs were applied for costs, and a 15-year time horizon was used. Results: Over 15 years, using a DTI approach, the undiscounted total costs for Device A vs Device C were 26 860 and 22 633, respectively, and 25 111 and 22 399 for Device B vs Device C, respectively. Compared with Devices A and B, Device C offered savings of 4227 and 2712, respectively; similar savings were predicted with a 2-step implant approach. Discussion: The battery longevity of NR-SCS devices directly impacts long-term costs to a payer. The longer the device lasts, the lower mean total cumulative costs the patient will have, especially with regard to device replacement costs. With novel devices and specific programming settings, the lifetime cost per patient to a payer can be decreased without compromising the patient's safety and positive clinical outcome. Conclusions: Extended SCS battery longevity can translate into tangible cost savings for payers. The DTI approach for SCS supports National Healthcare System cost efficiencies and offers the additional benefits of optimizing operating room time while having only one recovery period for the patient.
RESUMO
BACKGROUND: The treatment of end-stage chronic renal failure involves substantial costs for health care, which could be higher considering hemodialysis access complications management costs. Complications could be addressed by cannulation technique, but also by the needle. In particular, the use of a metal needle for cannulation is responsible for several complications that compromise dialysis delivery and require interventions. This analysis aims to evaluate, from a hospital perspective, the direct costs related to complications that may occur in hemodialysis patients in Italy. METHODS: To identify the main complications to consider in our analysis and related patient pathway for their management, we conducted an international literature search on PubMed and validated the data for Italy with an Italian Key Opinion Leader (KOL). A micro-costing analysis was developed to precisely assess the economic costs of healthcare interventions to manage complications due to vascular access cannulation. RESULTS: The major complications identified, and the average cost/per episode for their management are the following ones: Local infection 1455 (min 745 and max 2160); Sepsis, that requires hospitalization in ward 4401 (min 3693 and max 4623); Sepsis (ICU) 17,190; Hematoma 304 (min 252 and max 728); Aneurysm 3632 (min 3139 and max 4014); Pseudoaneurysm 3695 (min 3615 and max 4014); Stenosis 2229 (min 1874 and max 4857); Thrombosis 2151 (min 1941 and max 3395). CONCLUSIONS: In making decisions, hospital administration, and payer should take into consideration, not just the price of devices, but the entire patient's pathway. The use of plastic cannulae in hemodialysis patients shows improved outcomes compared to traditional metal needles. Furthermore, combining it with accurate and efficient cannulation techniques reduces complication rates, improves patients' quality of life, and reduces healthcare resource consumption.
