Table 19:
Estimated Annual Average Procedure Costs for SCS Systems Used in Ontario—Trial, Permanent Implantation, and Follow-up Care (Usual Care)
| Resource Item | Unit/Frequency | Cost Per Visit, $a | Data Source/Explanation |
|---|---|---|---|
| Trial | |||
| Preprocedure consultation, anesthesiologist | 1 | 106.15b | Schedule of Benefits (A015)73 |
| (pain doctor) or neurosurgeon | 160.00b | Schedule of Benefits (A935)73 | |
| Preprocedure consultation, average | 1 | 142.05b | Crude estimate accounting for variability in clinical practice |
| MRI, professional fee | 1 | 73.00 | Schedule of Benefits (X421)73 |
| MRI, procedure cost | 1 | 972.00 | OCCI 2016, ambulatory74 |
| MRI, average cost estimate, given that 80% of patients have MRI scans at consultation | — | 209.00 | Estimate (written communication, Aaron Hong, MD, December 2018) |
| X-ray, professional fee | 1 | 53.55 | Schedule of Benefits (X032)73 |
| X-ray, procedure cost | 1 | 76.00 | OCCI 2016, ambulatory74 |
| X-ray, total cost | — | 129.55 | — |
| SCS trial | 1 | 9,367.00 | OCCI 2016, ambulatory74 |
| Physician fees, anesthesiologist (pain doctor, including inserter fee for permanent neurosurgeon | 1 | 306.00b | Schedule of Benefits (Z942)73 |
| 739.50b,c | Schedule of Benefits (Z941A–Z943A)73 | ||
| 816.00b | Schedule of Benefits (N530)73 | ||
| Average cost, physician fees | 1 | 769.25b | Crude estimate accounting for variability in clinical practice |
| Anesthesiologist (sedation) | 6 | 51.95 | Schedule of Benefits (Z942)73 |
| Total average cost for trial procedured | — | 10,892.12 | Estimate accounting for permanent implant (high conversion rate) during the trial stage |
| Permanent Implantation | |||
| Procedure cost, inpatient or ambulatory | 1 | 17,566.00 | OCCI 2016, acute inpatient74 |
| 9,367.00 | OCCI 2016, ambulatory74 | ||
| Procedure cost, averagee | 1 | 15,926.20 | Crude estimate accounting for variability in clinical practice |
| Physician fees, pain doctor, inserter or neurosurgeon | 1 | 739.50 | Schedule of Benefits (Z941A-943A)73 |
| 510.00 | Schedule of Benefits (N563)73 | ||
| Physician fees, averagef | 1 | 555.90 | Crude estimate accounting for fees for permanent implant |
| Anesthesiologist (sedation) | 6 | 51.95 | Schedule of Benefits (Z942)73 |
| Total average cost for permanent implant procedureg | — | 10,552.10 | Estimate accounting for variations in conversion rate between centres |
| Follow-up Care | |||
| Consultation, reprogramming | 3 | 102.00 | Schedule of Benefits (Z943A)73 |
| Neuromodulation nurse | NA | NA | Covered by current bundle payment |
| Total cost for follow-up care | — | 306.00 | — |
| Overall Average Cost | $21,750.23 | Estimate accounting for permanent implant (high conversion rate) during the trial stageg | |
Abbreviation: SCS, spinal cord stimulation; MRI, magnetic resonance imaging; NA, not applicable; OCCI, Ontario Case Costing Initiative.
All costs are reported in 2018 Canadian dollars.
We assumed that in two of the six centres of excellence, the consultation and procedure would be done by pain doctors (written and oral communications, Aaron Hong, MD, and Anuj Bhatia, MD, PhD, November to December 2018). The preprocedure consultation fee for pain doctors was $106.15 and for neurosurgeons was $160, for an average of $142.05 for all centres of excellence.
Accounts for permanent implant inserter fees done in one centre of excellence (written communication, Aaron Hong, MD, December 2018).
Total costs adjusted for the fact that 5 centres of excellence proceed with permanent implant procedure, computed as follows: [($142.05 + $209.00 + $129.55 + $9,367.00 + $769.25 + $311.70) × 5 + ($142.05 + $209.00 + $129.55 + $9,367.00 + $769.25 + $311.70) × 0.98] ÷ 6 = $10,892.12.
Accounts for variability in practice and does not double-count the procedure cost for one centre of excellence where the SCS trial and permanent implantation were done at the same time with a high conversion rate, computed as follows: ($17,566.00 × 4 + $9,367.00) ÷ 5 = $15,926.20.
Accounts for variability in practice and does not double-count, computed as follows: ($739.50 + $510 × 4) ÷ 5 = $555.90.
Adjusted for the fact that five centres of excellence proceed with permanent implant procedure, computed as follows: [(5 × 0.75 × ($15,926.20 + $555.90 + $311.70) + (1 × 0.02 × ($15,926.20 + $555.90 + $311.70)] ÷ 6 = $10,552.10.