Rechargeable VS Non-Rechargeable - Is the Expense of Replacement Worth the Gamble for a Rechargeable Sacral Neuromodulation Device

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: Sacral neuromodulation (SNM) is a procedural treatment option for refractory overactive bladder (OAB). Currently, SNM units come in a rechargeable (RC) and a non-rechargeable (NRC) implantable pulse generator (IPG). The RC unit is smaller but requires (bi)weekly charging which can be a nuisance. This study has two objectives e to assess the healthcare expense and fiscal waste associated with replacement of a rechargeable SNM unit for the non-rechargeable unit; to investigate the role of patients’ body mass index (BMI) in the success of a RC unit. METHODS: This is a quality assessment, retrospective study of patients who have undergone placement of a Medtronic® RC SNM unit at a single institution. Patients included for study underwent stage 1 and 2 placements of the Medtronic® RC SNM device from August 2020 through February 2024. We identified patients who underwent explant of RC SNM unit and whether replacement with the Medtronic® NRC SNM unit was performed. Reasons for explant were identified. Healthcare expenses were calculated based on the physician and the hospital reimbursements. Averaged fees were calculated using standardized CPT codes through the CMS website reimbursement tool (fiscal year 2024B) and Medtronic® 2024 sacral nerve stimulation coding and payment guide. RESULTS: A total of 86 patients (17 males and 69 females) with the mean age of 52.4 years (22.6-84.8) had a RC SNM device. Among those implanted, 14 (16.3%) eventually had the device removed. Of these, 10 (71.4%) had charging difficulties and underwent replacement with a NRC SNM unit on average 2.1 years (0.6-3.4 years) after initial placement. Of the remaining 4 removed: 1 was due to infection, 2 secondary to dissatisfaction with treatment outcome, and 1 for complete symptom resolution. No differences were found in mean BMI between patients who replaced their SNM devices (28.9±6.8) and patients who did not undergo device removal (28.7±8.7, p-value =0.936). The average physician and hospital costs for SNM device placement were $591.34 and $27,510 respectively. For the 10 who underwent removal and replacement with a non-rechargeable SNM the total additional cost was $281,013.40. CONCLUSIONS: BMI did not appear to play a role in the charging difficulties with the RC unit. While the Medtronic® RC device accounts for less than 5% of the market, there is a significant cost and fiscal waste associated with the exchange of a SNM unit prior to the device end of life.

Volume

213

Issue

5S

First Page

e1354

Last Page

e1355

Comments

American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV

DOI

10.1097/01.JU.0001110196.19418.44.10

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