Table 20:
Estimated Annual Procedure Average Costs for the Freedom SCS System—Trial, Permanent Implantation, and Follow-up Care (Intervention, Future Scenario)
| Resource Item | Unit/Frequency | Cost Per Visit, $a | Data Source/Explanation |
|---|---|---|---|
| Trial/Permanent Implantation | |||
| Preprocedure consultation, anesthesiologist (pain doctor) or neurosurgeon | 1 | 106.15b 160.00b |
Schedule of Benefits (A015)73 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 one-step procedure | 1 | 9,367.00 | OCCI 2016, ambulatory74 |
| Physician fees, anesthesiologist (pain doctor, including inserter fee for permanent trial) or neurosurgeon | 1 | 306.00b 739.50b,c 816.00b |
Schedule of Benefits (Z942)73 Schedule of Benefits (Z941A–Z943A)73 Schedule of Benefits (N530)73 |
| Average cost, physician fees | 1 | 892.50b | Crude estimate accounting for variability in clinical practice |
| Anesthesiologist (sedation) | 6 | 51.95 | Schedule of Benefits (Z942)73 |
| Total average cost for SCS procedure | 11,051.80d | Estimate accounting for trial and permanent implant | |
| Follow-up Care | |||
| Procedure cost, inpatient or ambulatory | NA | NA | OCCI 2016, acute inpatient74 OCCI 2016, ambulatory74 |
| Physician fees, pain doctor or neurosurgeon | 1 | 306.00 | Schedule of Benefits (Z942)73 |
| Reprogramming, first year | 3 | 102.00 | Schedule of Benefits (Z943A)73 |
| Neuromodulation nurse | NA | NA | Covered by current bundle payment |
| Total cost for follow-up care | — | 612.00 | — |
| Overall Average Cost | 11,663.80 | Estimate accounting for permanent implant (high conversion rate) during the trial stage | |
Abbreviation: SCS, spinal cord stimulation; MRI, magnetic resonance imaging; NA, not applicable; OCCI, the 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 + $892.50 + $311.70 = $11,051.80.