Longevity and Utilization Cost of Rechargeable and Non-Rechargeable Spinal Cord Stimulation Implants: A Comparative Study.

INTRODUCTION Despite major advancements in features and capabilities of the implantable pulse generator (IPG), real life longevity and cost-effectiveness studies to guide pain specialist to make the appropriate choice between rechargeable and non-rechargeable IPG are limited. Our study aims to compare the longevity and cost effectiveness of rechargeable vs. non-rechargeable IPG and SCS systems. METHODS Data were collected for all SCS implants between 1994- 2018. The primary goal is to determine the IPG longevity, defined as the time interval between IPG implant and elective replacement due to IPG end of life (EOL). On the other hand, SCS system longevity was defined as the time between the SCS implant and its removal or revision for any reason other than IPG EOL. Kaplan Meyer and Log-rank tests were used to assess IPG and SCS system longevities. Cost analysis was performed for cost effectiveness. RESULTS The median for IPG longevity was significantly higher for rechargeable SCS than the non-rechargeable SCS (7.20 years and 3.68 years, respectively). The median cost per day was similar for both IPGs with $13.90 and $13.81 for non-rechargeable and rechargeable, respectively. The median cost for SCS system was higher for the rechargeable ($60.70) when compared the non-rechargeable group ($31.38). CONCLUSIONS Rechargeable IPG had increased longevity compared to the non-rechargeable, yet there was no significant difference in the actual longevity due to premature revisions or explants between both SCS systems. Furthermore, non-rechargeable SCS systems were found to be the more cost-effective option when compared with rechargeable SCS systems.