Systemic-opioid prescribing patterns and total cost of care in patients initiating spinal cord stimulation therapy: a retrospective analysis.

BACKGROUND Few studies have evaluated patterns of systemic opioid use among patients initiating spinal cord stimulation therapy for chronic pain. This study evaluated systemic opioid discontinuation and/or dose reduction, and total healthcare cost following start of spinal cord stimulation therapy. METHODS Using a commercial insurance claims database (2008-2017), we analyzed opioid utilization patterns in patients initiating spinal cord stimulation therapy, over a 1-year baseline and 2 year follow-up. The primary endpoint was defined as either discontinuation (= 365-day gap between prescription fills or total days' supply in follow-up = 30 days) OR = 50% reduction in average daily morphine milligram equivalent dose. "Costs" were defined as total payer plus patient out-of-pocket payments. RESULTS 5,878 patients met selection criteria. 152 (2.6%) showed no opioid prescription data at any point in the study period. Among patients with one or more prescriptions, 42.0% met the primary endpoint (22.0% discontinued and 20.0% reduced their dose by 50% or more). Mean total adjusted costs were significantly reduced in years 1 and 2 of follow-up relative to baseline (excluding device insertion costs). The average time to breakeven when accounting for device trial and permanent insertion cost was 3.1 years among those that met the composite endpoint and 4.2 years among those who did not. CONCLUSIONS This analysis shows that among patients who continue spinal cord stimulation therapy for at least two years, a significant proportion were able to reduce and/or discontinue systemic opioid use, with costs following start of therapy significantly reduced relative to baseline.