Health Care Resource Utilization and Medical Costs of Spinal Cord Injury With Neuropathic Pain in a Commercially Insured Population in the United States

Objective: To evaluate health care resource use, costs, and cost drivers among patients with neuropathic pain (NeP) after spinal cord injury (SCI) in a commercially insured population. Design: Retrospective longitudinal cohort study comparing SCI patients with and without NeP. Setting: Truven Health MarketScan commercial claims database from 2005 through 2012. Participants: Commercially insured SCI patients with NeP (n=3524) propensity score matched to SCI patients without NeP (n=3524). Interventions: Not applicable. Main Outcomes Measures: Health care resource utilization and expenditures for the 12 months after NeP onset (index event; identified through International Classification of Diseases, 9th Revision, Clinical Modification diagnosis 338.0x or use of NeP-specific antiepileptic drugs or NeP-specific antidepressants) in patients with SCI compared with matched patients without NeP. Results: Utilization over 12 months postindex among patients with SCI-associated NeP was higher than among SCI-only patients for inpatient admissions (27.4% vs 22.1%), emergency department visits (36.7% vs 26.4%), and office visits per patient (mean +/- SD: 13.0 +/- 9.5 vs 9.5 +/- 8.3); all P values were <.001. All-cause expenditures showed adjusted incremental costs of $22,545 (95% confidence interval, $19,010 $26,168) per patient with SCI-associated NeP during the 12-month postindex period. Conclusions: Patients with evidence of NeP secondary to SCI have significantly higher health care utilization and total costs compared with SCI patients without evidence of NeP. Factors contributing to NeP in patients with SCI need to be clinically assessed to determine the optimal approach for treating these individuals. (C) 2014 by the American Congress of Rehabilitation Medicine