Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation

Abstract

Objective: The diagnosis and treatment of complex regional pain syndrome (CRPS) is challenging and there is a paucity of data describing its overall cost burden and quantifying its impact on the US healthcare system. The aim of this study was to assess the prevalence and healthcare utilization costs associated with CRPS.

Materials and methods: A retrospective longitudinal study was performed using the Truven MarketScan® database to identify patients with a new indexed diagnosis of CRPS (Type I, II, or both) from 2001 to 2012. We collected total, outpatient, and pain prescription costs three years prior to CRPS diagnosis (baseline), at year of CRPS diagnosis, and eight-year post-CRPS diagnosis. A longitudinal multivariate analysis was used to model the estimated total and pain prescription cost ratios comparing patients diagnosed before and after CRPS.

Results: We included 35,316 patients with a newly indexed diagnosis of CRPS (Type I: n = 18,703, Type II: n = 14,599, Unspecified: n = 2014). Baseline characteristics were similar between the CRPS cohorts. Compared to two- and three-year baseline costs, one-year prior to diagnosis for all CRPS patients yielded the highest interquartile median [IQR] costs: total costs $7904[$3469, $16,084]; outpatient costs $6706[$3119, $12,715]; and pain prescription costs $1862[$147, $7649]. At the year of CRPS diagnosis, the median [IQR] costs were significantly higher than baseline costs: total costs $8508[$3943, $16,666]; outpatient costs $7251[$3527, $13,568]; and pain prescription costs $2077[$140, $8856]. Over the eight-year period after CRPS diagnosis, costs between all the years were similar, ranging from the highest (one-year) to lowest (seven-years), $4845 to $3888. The median total cumulative cost 8-years after CRPS diagnosis was $43,026 and $12,037 for pain prescription costs. [Correction added on 06 November 2017 after first online publication: the preceding sentence has been updated to demonstrate the median cumulative cost in replacement of the additive cumulative mean costs.]. During the CRPS diagnosis period, patients are expected to have a total cost 2.17-fold and prescription cost 2.56-fold of their baseline cost annually.

Conclusions: Our study demonstrates that there is a significant increase in cost and healthcare resource utilization one-year prior to and around the time of CRPS diagnosis. Furthermore, there is an increased annual cost post-diagnosis compared to baseline costs prior to CRPS diagnosis.

Keywords: CRPS; Complex regional pain syndrome; SCS; cost; healthcare utilization; neuromodulation.

Conflict of interest statement

Conflict of Interest Disclosure: Shivanand Lad, MD, PhD, has consulted for and received grant support from Medtronic Inc., Boston Scientific and St. Jude Medical. None of the above contributed to the writing of the manuscript, payment or decision to submit for publication. He serves as Director of the Duke Neuro-Outcomes Center, which has received research funding from NIH KM1 CA 156687, Medtronic Inc. and St. Jude Medical. The remaining authors report no conflicts of interest.

© 2017 International Neuromodulation Society.

Figures

Figure 1

Consort Diagram

Figure 2

Annual Median Total Costs Prior and After CRPRS Diagnosis

Figure 3

Annual Median Pain Prescription Costs Prior and After CRPRS Diagnosis

Figure 4

Cumulative Median Total Cost Per Patient Overtime Post-CRPS Diagnosis

Figure 5

Cumulative Median Pain Prescription Per Patient Overtime Post-CRPS Diagnosis