PMID- 28961359 OWN - NLM STAT- MEDLINE DCOM- 20181030 LR - 20220210 IS - 1525-1403 (Electronic) IS - 1094-7159 (Print) IS - 1094-7159 (Linking) VI - 21 IP - 5 DP - 2018 Jul TI - Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation. PG - 423-430 LID - 10.1111/ner.12691 [doi] AB - 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(R) 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. CI - (c) 2017 International Neuromodulation Society. FAU - Elsamadicy, Aladine A AU - Elsamadicy AA AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. FAU - Yang, Siyun AU - Yang S AD - Department of Biostatistics, Duke University Medical Center, Durham, NC, USA. FAU - Sergesketter, Amanda R AU - Sergesketter AR AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. FAU - Ashraf, Bilal AU - Ashraf B AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. FAU - Charalambous, Lefko AU - Charalambous L AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. FAU - Kemeny, Hanna AU - Kemeny H AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. FAU - Ejikeme, Tiffany AU - Ejikeme T AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. FAU - Ren, Xinru AU - Ren X AD - Department of Biostatistics, Duke University Medical Center, Durham, NC, USA. FAU - Pagadala, Promila AU - Pagadala P AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. FAU - Parente, Beth AU - Parente B AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. FAU - Xie, Jichun AU - Xie J AD - Department of Biostatistics, Duke University Medical Center, Durham, NC, USA. FAU - Lad, Shivanand P AU - Lad SP AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. LA - eng GR - KL2 TR001115/TR/NCATS NIH HHS/United States GR - KM1 CA156687/CA/NCI NIH HHS/United States GR - UL1 TR001117/TR/NCATS NIH HHS/United States PT - Journal Article PT - Review DEP - 20170929 PL - United States TA - Neuromodulation JT - Neuromodulation : journal of the International Neuromodulation Society JID - 9804159 SB - IM MH - Adult MH - Aged MH - *Complex Regional Pain Syndromes/economics/epidemiology/therapy MH - Costs and Cost Analysis/*methods MH - Disability Evaluation MH - Female MH - Humans MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Patient Acceptance of Health Care/statistics & numerical data MH - Prevalence MH - Regression Analysis MH - Retrospective Studies MH - United States PMC - PMC5876058 MID - NIHMS900064 OTO - NOTNLM OT - CRPS OT - Complex regional pain syndrome OT - SCS OT - cost OT - healthcare utilization OT - neuromodulation COIS- 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. EDAT- 2017/09/30 06:00 MHDA- 2018/10/31 06:00 PMCR- 2019/07/01 CRDT- 2017/09/30 06:00 PHST- 2017/05/17 00:00 [received] PHST- 2017/07/14 00:00 [revised] PHST- 2017/07/31 00:00 [accepted] PHST- 2017/09/30 06:00 [pubmed] PHST- 2018/10/31 06:00 [medline] PHST- 2017/09/30 06:00 [entrez] PHST- 2019/07/01 00:00 [pmc-release] AID - S1094-7159(21)02257-1 [pii] AID - 10.1111/ner.12691 [doi] PST - ppublish SO - Neuromodulation. 2018 Jul;21(5):423-430. doi: 10.1111/ner.12691. Epub 2017 Sep 29.