title: Disparities in the Use of Sacral Neuromodulation among Medicare Beneficiaries.
abstract: OBJECTIVE
  Sacral neuromodulation with the InterStim® has been done to treat urinary and bowel control. There are limited data in the literature on use trends of sacral neuromodulation. We explored disparities in use among Medicare beneficiaries.
  
  
  METHODS
  We queried a 5% national random sample of Medicare claims for 2001, 2004, 2007 and 2010. All patients with an ICD-9 diagnosis code representing a potential urological indication for sacral neuromodulation were included. Patients who underwent device implantation were identified using CPT-4 codes. Statistical analysis was done with the chi-square and Fisher tests, and multivariate logistic regression using software.
  
  
  RESULTS
  A total of 2,322,060 patients were identified with a diagnosis that could potentially be treated with sacral neuromodulation. During the 10-year study period the percent of these patients who ultimately underwent implantation increased from 0.03% to 0.91% (p <0.0001) for a total of 13,360 (0.58%). On logistic regression analysis women (OR 3.85, p <0.0001) and patients younger than 65 years (OR 1.00 vs 0.29 to 0.39, p <0.0001) were more likely to be treated. Minority patients (OR 0.38, p <0.0001) and those living in the western United States (OR 0.52, p <0.0001) were less likely to receive treatment.
  
  
  CONCLUSIONS
  Sacral neuromodulation use significantly increased among Medicare beneficiaries in a 10-year period. Patients were more likely to be treated with sacral neuromodulation if they were female, white, younger (younger than 65 years) and living outside the western United States.
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Laudano
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York; Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Seklehner
authors.affiliation: Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Sandhu
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: W Stuart
authors.initials: WS
authors.lastname: Reynolds
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Garrett
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Te
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kaplan
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York. Electronic address: ril9010@med.cornell.edu.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000191:economics / Q000295:instrumentation*; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D006278:Medicare / Q000191:economics*; D012189:Retrospective Studies; D014481:United States; D053201:Urinary Bladder, Overactive / Q000191:economics / Q000628:therapy*
keywords: Medicare; electric stimulation; fecal incontinence; lower urinary tract symptoms; urinary bladder