Health care utilization and expenditures among Medicaid beneficiaries with neuropathic pain following spinal cord injury

Journal of Pain Research, 2014 · DOI: http://dx.doi.org/10.2147/JPR.S63796 · Published: July 1, 2014

Spinal Cord Injury Healthcare Pain Management

Simple Explanation

This study looks at the costs and healthcare usage for people on Medicaid who have both spinal cord injuries (SCI) and nerve pain (neuropathic pain or NeP). Researchers compared those with SCI and NeP to those with only SCI to see how much extra NeP adds to healthcare expenses. The study found that people with both SCI and NeP used more healthcare services and had higher medical costs than those with only SCI.

Study Duration

12 months postindex

Participants

546 Medicaid beneficiaries with SCI and neuropathic pain, 546 matched controls with SCI only

Evidence Level

Not specified

Key Findings

1
Patients with SCI-NeP had significantly higher percentages of physician office visits, emergency department visits, SCI- and pain-related procedures, and outpatient prescription utilization compared to the SCI-only cohort.
2
Adjusted mean expenditures were US$47,518 for SCI-NeP and US$30,150 for SCI only, yielding incremental costs of US$17,369 for SCI-NeP.
3
Factors significantly associated with increased cost included SCI type, trauma-related SCI, and comorbidity burden.

Research Summary

The study evaluated health care resource utilization (HRU) and costs for neuropathic pain (NeP) secondary to spinal cord injury (SCI) among Medicaid beneficiaries. Significantly higher HRU and total costs were incurred by Medicaid patients with NeP secondary to SCI compared with matched SCI-only patients. The adjusted economic burden of SCI-NeP during the year following NeP diagnosis ($47,518) was higher than that of SCI-only patients ($30,149), representing a significant incremental burden of $17,369.

Practical Implications

Economic Burden Awareness

Highlights the substantial economic burden of neuropathic pain in SCI patients within the Medicaid system, which is higher than previously estimated.

Targeted Treatment Approaches

Suggests the need for a more encompassing, multifactorial approach to treating pain following SCI, considering the high comorbidity and medication burden.

Non-Opioid Pharmacotherapy Emphasis

Given the high rate of substance abuse in SCI patients, supports greater use of nonopioid pharmacotherapy in multimodal treatment plans.

Study Limitations

1
Causality cannot be determined; observed relationships are associative.
2
Potential for misclassifying, undercoding, or overcoding the diagnoses of interest using claims data.
3
The use of AEDs and antidepressants as proxies to identify NeP represents another limitation.

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