The experience of low back pain in people with incomplete spinal cord injury in the USA, UK and Greece

Engineering and Physical Sciences Research Council's (EPSRC

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

Jay M Margolis,1 Paul Juneau,1 Alesia Sadosky,2 Joseph C Cappelleri,3 Thomas N Bryce,4 Edward C Nieshoff5 1Truven Health Analytics, Bethesda, MD, USA; 2Pfizer Inc., New York, NY, USA; 3Pfizer Inc., Groton, CT, USA; 4Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA Background: The study aimed to evaluate health care resource utilization (HRU) and costs for neuropathic pain (NeP) secondary to spinal cord injury (SCI) among Medicaid beneficiaries. Methods: The retrospective longitudinal cohort study used Medicaid beneficiary claims with SCI and evidence of NeP (SCI-NeP cohort) matched with a cohort without NeP (SCI-only cohort). Patients had continuous Medicaid eligibility 6 months pre- and 12 months postindex, defined by either a diagnosis of central NeP (ICD-9-CM code 338.0x) or a pharmacy claim for an NeP-related antiepileptic or antidepressant drug within 12 months following first SCI diagnosis. Demographics, clinical characteristics, HRU, and expenditures were compared between cohorts. Results: Propensity score-matched cohorts each consisted of 546 patients. Postindex percentages of patients with physician office visits, emergency department visits, SCI- and pain-related procedures, and outpatient prescription utilization were all significantly higher for SCI-NeP (P<0.001). Using regression models to account for covariates, adjusted mean expenditures were US$47,518 for SCI-NeP and US$30,150 for SCI only, yielding incremental costs of US$17,369 (95$9,753 to US$26,555) for SCI-NeP. Factors significantly associated with increased cost included SCI type, trauma-related SCI, and comorbidity burden. Conclusion: Significantly higher HRU and total costs were incurred by Medicaid patients with NeP secondary to SCI compared with matched SCI-only patients. Keywords: spinal cord injuries, burden of illnes