title: Automated vs. Manual Spinal Cord Stimulator Adjustment: A Sensitivity Analysis of Lifetime Cost Data From a Randomized Controlled Trial.
abstract: Objective.  In a randomized controlled trial comparing manual with automated computerized adjustment of spinal cord stimulators in patients with implanted power generators, automated adjustment conferred the following advantages: 1) more settings tested in a given time, 2) significantly greater pain/paresthesia overlap, 3) increased battery life, and 4) a $303,756 (95% confidence intervals = $116,503-491,009) reduction in lifetime per patient cost. The current study analyzes the sensitivity of this cost-savings to usage time/day, inflation, discount rate, and years of use. Methods.  We analyzed cost-sensitivity with a standard spreadsheet method and suitably adjusted standard equation. Results.  Regardless of hours of use/day, inflation, discount rate, or years of use, spinal cord stimulation remains significantly less expensive with automated rather than manual adjustment. This savings is attributable to increased battery life. Conclusion.  Sensitivity analyzes reveal that the significant cost-savings achieved with computerized, patient-directed adjustment of spinal cord stimulation in selected patients with chronic pain is robust across a representative range of parameters.
authors.affiliation: Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA;              Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK;              Stimsoft Inc., 1000 Century Plaza, Suite 313, 10630 Little Patuxent Parkway, Columbia, MD, USA; and              Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Khalessi
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.forename: David
authors.initials: D
authors.lastname: Brigham
authors.forename: Richard B
authors.initials: RB
authors.lastname: North