Sacral neuromodulation (SNM) placement in a single-stage procedure is likely to be less costly than a two-stage approach for most practitioners, according to the findings of a cost minimization analysis.
The research, which was presented at the AUA annual meeting in Chicago, showed that the potential for savings and the amount were tied to SNM success rates and reimbursement rates. In the ambulatory surgery center (ASC) setting, performing a single-stage procedure became potentially economically advantageous when the success rate of a two-stage procedure was ≥65.4%. For procedures done in an outpatient hospital department (OHD), the minimum SNM success rate needed to achieve savings with a single-stage operation was 61.4%.
Both of those thresholds are below the reported national average success rate of 69%, said Andrew J. Sun, MD, a urology resident at Stanford University, Stanford, CA.
Cost savings up to $5,000 per case
At the two thresholds, the modeling determined that there would be an approximate $600 savings for procedures done in an ASC and an approximate savings of $1,350 for OHD procedures. At centers of excellence where the success rates are reported to be around 90%, the cost savings were estimated to reach approximately $5,000 per case, reported Dr. Sun, working with Christopher Elliott, MD, PhD, and colleagues.
“Payers control what we as practitioners can do. Currently, Medicare is the payer for the majority of SNM procedures and requires that placement be done in a two-stage approach,” he said.
“Our estimates are from theoretical models and do not incorporate the benefits of a single-stage procedure from the patient preference perspective, but we tried to make them as realistic and generalizable as we could. We hope that our findings will motivate payers to revisit their policies. It is notable that Kaiser Permanente, which is a closed system, has gone to a single-stage procedure in Southern California, likely reflecting the economic advantages of the single-stage approach.”
The base model used published data on SNM variables when available and 2017 national average reimbursements from Medicare for cost data.
“A previous study modeling the potential cost savings of a single-stage procedure used institution specific success rate and cost data. Therefore, its findings may not be generalizable,” Dr. Sun said.