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Rebecca Fancini, Public and Media Relations , +44 1923 212 213

New study finds spinal cord stimulation pays for itself in 2.5 years

Compared with other pain therapies, implant costs for innovative treatment are offset by reductions in post-implant costs over 1-3 years

07 April 2004 – Beyond the documented relief provided to victims of chronic pain, a systematic review of the literature of spinal cord stimulation (SCS) suggests that the therapy also offers economic benefits by paying for itself in less than 2.5 years, according to a report in the current issue of the Journal of Pain and Symptom Management.

The initial cost of the therapy, which uses an implantable device akin to a cardiac pacemaker to block pain signals moving up the spinal cord, does not represent the therapy’s overall costs and benefits, say five collaborating researchers from U.S. and European medical centres. Health policy decisions that restrict patient access to SCS on the basis of device and implantation costs alone should be reconsidered on the basis of data comparing its cost over one to three years with other pain therapies, according to the article, “The Cost Effectiveness of Spinal Cord Stimulation in the Treatment of Pain.”

Chronic pain – defined as pain that persists or recurs for more than three months – can be caused by a variety of injuries and diseases, including nerve damage and cancer. In the U.K. alone, almost one in four of the population 1 is afflicted, costing £12.3 billion a year - £1.6 billion to the NHS and £10.7 billion in lost productivity and other indirect costs2 - and resulting in 206 million lost workdays.3 The most common chronic pain problems involve the lower back and legs.

Implantable neurostimulation systems from Medtronic, Inc. (NYSE: MDT), have been used to treat chronic intractable pain syndrome in about 130,000 patients since the systems’ commercial introduction in 1981.

Led by Rod Taylor, Ph.D., a leading health economist in the Department of Public Health and Epidemiology at the University of Birmingham, the researchers reviewed and evaluated cost data from 14 carefully selected studies at medical centres around the world. These studies described cases of patients treated with SCS for numerous symptoms, including chronic back and leg pain, failed back surgery syndrome and complex regional pain syndrome, a rare but debilitating condition.

“Across a range of medical indications, we found that the initial healthcare acquisition costs of SCS implantation are consistently offset by a reduction in post-implant healthcare resource demand and costs,” says the report.

The researchers found large variations in costs associated with the initial implant of a neurostimulation device (patient screening, device costs, physician/surgeon fees, and hospitalisation) and for the post-implantation period (drugs, follow-up visits, implant revision and physical therapy). Initial implant costs ranged from $8,796 to $19,500 (approximately £5,000 to £11,000). However, the researchers said that, “although for two years post implant the cumulative costs of SCS were in excess of those associated with non-SCS patients, the pattern reversed after about 2.5 years as patients without SCS underwent more physician visits, specialist consultations, re-hospitalisation, ongoing therapy and diagnostic tests.”

In one study they reviewed, initial SCS costs per patient were $16,936 (Canadian), but their maintenance cost dropped to $1,094 (Canadian) a year compared with $7,291 (Canadian) for patients who were not treated with SCS. Overall, this study estimated that lifetime cost savings of $60,000 (US), approximately £33,500, for patients receiving SCS and physical therapy over patients receiving only physical therapy.

Using standard cost-effectiveness metrics in pain management (cost per pain-free day and cost per quality-adjusted life year), the study found that “cost payback” periods as short as 15 months have been recorded, depending on relative effectiveness of SCS, generator battery life, and the level of SCS usage by patients.

“The result of this review raise important issues for health care policymakers, at a national or local level, who need to consider medium- to long-term costs, as opposed to initial, or startup, costs alone,” the researchers concluded.

Medtronic, Inc., headquartered in Minneapolis, is the world’s leading medical technology company, providing lifelong solutions for people with chronic disease. More information about implantable neurostimulation systems and spinal cord stimulation for the treatment of chronic pain can be found at www.medtronic.co.uk and at www.tamethepain.co.uk.

1 Elliot, et al. The epidemiology of chronic pain in the community. Lancet 1999.
2 Mandiakis N, Gray A. The economic burden of pain in the UK. Pain (84) 2000; 95-103
3 Arthritis Research Campaign. Arthritis: The Big Picture. 2003

Any statements made about the company’s anticipated financial results and regulatory approvals are forward-looking statements subject to risks and uncertainties such as those described in Medtronic’s Annual Report on Form 10-K for the year ended April 25, 2003. Actual results may differ materially from anticipated results.

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