Reduced long-term cost and increased patient satisfaction with rechargeable implantable pulse generators for deep brain stimulation

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OBJECTIVE

Deep brain stimulation (DBS) has revolutionized the treatment of neurological disease, but its therapeutic efficacy is limited by the lifetime of the implantable pulse generator (IPG) batteries. At the end of the battery life, IPG replacement surgery is required. New IPGs with rechargeable batteries (RC-IPGs) have recently been introduced and allow for decreased reoperation rates for IPG replacements. The authors aimed to examine the merits and limitations of these devices.

METHODS

The authors reviewed the medical records of patients who underwent DBS implantation at their institution. RC-IPGs were placed either during initial DBS implantation or during an IPG change. A cost analysis was performed that compared RC-IPGs with standard IPGs, and telephone patient surveys were conducted to assess patient satisfaction.

RESULTS

The authors identified 206 consecutive patients from 2011 to 2016 who underwent RC-IPG placement (mean age 61 years; 67 women, 33%). Parkinson’s disease was the most common indication for DBS (n = 144, 70%), followed by essential tremor (n = 41, 20%), dystonia (n = 13, 6%), depression (n = 5, 2%), multiple sclerosis tremor (n = 2, 1%), and epilepsy (n = 1, 0.5%). DBS leads were typically placed bilaterally (n = 192, 93%) and targeted the subthalamic nucleus (n = 136, 66%), ventral intermediate nucleus of the thalamus (n = 43, 21%), internal globus pallidus (n = 21, 10%), ventral striatum (n = 5, 2%), or anterior nucleus of the thalamus (n = 1, 0.5%). RC-IPGs were inserted at initial DBS implantation in 123 patients (60%), while 83 patients (40%) were converted to RC-IPGs during an IPG replacement surgery. The authors found that RC-IPG implantation resulted in $60,900 of cost savings over the course of 9 years. Furthermore, patient satisfaction was high with RC-IPG implantation. Overall, 87.3% of patients who responded to the survey were satisfied with their device, and only 6.7% found the rechargeable component difficult to use. In patients who were switched from a standard IPG to RC-IPG, the majority who responded (70.3%) preferred the rechargeable IPG.

CONCLUSIONS

RC-IPGs can provide DBS patients with long-term therapeutic benefit while minimizing the need for battery replacement surgery. The authors have implanted rechargeable stimulators in 206 patients undergoing DBS surgery, and here they demonstrate the cost-effectiveness and high patient satisfaction associated with this procedure.

ABBREVIATIONS DBS = deep brain stimulation; IPG = implantable pulse generator; RC-IPG = rechargeable IPG.

Article Information

Correspondence Frederick Hitti: University of Pennsylvania, Philadelphia, PA. frederick.hitti@uphs.upenn.edu.

INCLUDE WHEN CITING Published online September 28, 2018; DOI: 10.3171/2018.4.JNS172995.

F.L.H. and K.A.V. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Patient comorbidities as determined by chart review are listed in order of frequency. HTN = hypertension; Psych = psychiatric; HLD = hyperlipidemia; DM = diabetes mellitus; CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; Afib = atrial fibrillation; DVT/PE = deep vein thrombosis or pulmonary embolus; CHF = congestive heart failure.

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    Initial IPG. The majority of the patients in this study initially underwent implantation of an RC-IPG. In patients implanted with an RC-IPG at the time of battery depletion, the majority previously had Medtronic Kinetra or Activa PC stimulators. SC = Activa SC.

  • View in gallery

    IPG costs. RC-IPG implantation is associated with significant cost savings if long-term costs, including IPG replacements, are considered.

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