Does Competition Impact Cost of Sacral Neuromodulation?

Objectives: Sacral neuromodulation (SNM) is a therapeutic option for urinary retention, urge urinary incontinence (UUI), and fecal incontinence. The procedure’s cost is primarily driven by the neurostimulator implant and the supplies needed to implant the device. This study sought to explore how competition between device manufacturers would affect the cost of SNM surgery at our academic institution, hypothesizing that the traditional effect of competition may be disrupted in the academic healthcare marketplace.

Methods: This study is a retrospective cohort study at an urban academic center, of 82 patients who underwent combined Stage 1 & 2 SNM surgery for UUI, from May 2016 to June 2023. All surgeons within the study had no financial relationship with either implant manufacturer. Patients who underwent staged implantation, implant removal only, or had bilateral implants were excluded. Total implant cost data, which encompassed the cost of supplies and the neurostimulator implant, was collected from the electronic medical record. Other variables assessed included anesthesia time, implant manufacturer, and surgery date. For this study, we have labeled the original implant manufacturer’s product “Implant A” and the new competitor’s product “Implant B”. Comparisons in total implant cost were made based on implant manufacturer, and pre- and post-2020 implantation surgery date. Categorical variables were compared using a Wilcoxan rank sum test and continuous variables were compared using a t-test with statistical significance considered p< 0.05.

Results: Of the 82 patients in the data set, 32 (39.0%) received “Implant A” and 50 (61.0%) received “Implant B”. There was no difference in average anesthesia time between the groups (98 vs. 99 minutes). However, there was a difference in average total implant cost ($17,177 vs. $16,200, p < .05) between “Implant A” and “Implant B”, respectively. When comparing the pre- and post-2020 surgery date groups, we found no differences in anesthesia time (95 vs 99 minutes) or total implant cost ($16,456 vs. $16,648) across the two time periods for the cohort. Additionally, when looking specifically at the total implant cost for “Implant A” devices, between the pre- and post-2020 surgery date groups, there was an increase from $16,456 to $17,670.

Conclusions: We found that although, on average, a procedure with “Implant B” was cheaper than with “Implant A”, there was no significant change in total implant cost in the post-2020 period. Interestingly, the total implant cost of the “Implant A” device increased in the post-2020 period, following the introduction of the competing “Implant B” device. Competition failed to drive down the costs of SNM at our single academic institution. Therefore, future studies involving multiple academic institutions are needed to examine if the findings at our institution extend across the broader SNM market.