Comparison of patients undergoing a two-stage sacral nerve stimulation procedure: is there a cost benefit for a single-stage procedure?

AIMS: Sacral neurostimulation (SNS) involves a two-stage procedure to assess outcomes prior to permanent implantation. Stage 1 involves placement of a sacral lead that is externalized and tested for 2 weeks. Stage 2 is the implantation of a pulse generator in responders (≥ 50% improved). This study's purpose was to determine the overall response rate, costs of a two-staged versus single-stage approach, and explore predictors of a positive response.

METHODS: A prospective database of 145 patients undergoing SNS was analyzed. Demographics, history, and operative data were collected from the medical records. Cost data were collected from our institutions' reported average reimbursement for all stages of Interstim implantation and explantation in 2008. Wilcoxon rank test were used for analysis.

RESULTS: Of 145 patients, 131 (90.3%) progressed to Stage 2 and 14 (9.7%) had removal. Explanted patients were older (mean 63 years) than implanted patients (56 years); however, this was not statistically significant. Total Medicare and Blue Cross/Blue Shield (BCBS) reimbursement for a two-stage procedure was calculated at $21,428/case and $26,968. Implanting the lead and generator as a single-stage would cost Medicare and BCBS $20,696 and $21,602, respectively. Since 9.7% were explanted, overall cost saving might be significant: a single-stage approach would yield savings of $3,655/case (BC/BS) over a two-stage approach (after the cost of explantation is factored in).

CONCLUSIONS: The majority of patients tested with SNS would benefit from a single-stage procedure (90.3%). This would reduce operative and anesthesia risks, time lost from work, and burden on patients and providers.