Shaking Our Drug Habit

Since its beginnings, the neurotechnology industry has had to contend with playing second fiddle to the pharmaceutical industry. In many instances, neurotech therapies are only considered after all available drug therapies have failed to alleviate symptoms in an individual with a neurological disease or disorder. While addressing treatment-resistant populations in conditions such as chronic pain, epilepsy, movement disorders, and psychiatric disorders has produced significant revenues for many neurotech device vendors, the road to market and profitability is long and complicated, in large part because of regulators and reimbursement agencies that favor drugs over devices.

This is beginning to change.

One impetus for this change is society’s increasing awareness of the problems caused by overmedication. As we have discussed in this space, the opioid epidemic in the U.S. has been caused at least in part by clinicians’ and patients’ failure to consider nonpharmacological therapies for treating chronic pain, including neuromodulation devices.

But overall cost is another significant factor that is beginning to sink in to payers and regulators. A recent article published in the Journal of Parkinson’s Disease by investigators at Vanderbilt University suggests that early-stage PD subjects treated with DBS required significantly less medication than those using drug therapy alone. This translates to a cost savings of $64,000 over 10 years, more than the cost of the device and implantation. Another study in the journal Neuromodulation: Technology at the Neural Interface reported that delaying the use of SCS in individuals with chronic pain by even one year increased the odds by 33 percent that patients would end up in the high medical expenditures group ($4133 or more) as opposed to the low group ($603 or less). And the odds increased by 39 percent that patients would end up in the high opioid prescription group. Office visits and hospitalization also became much more likely with delayed SCS use.

And as we report on page 3 of this issue, Neuronetics recently cited an article in the journal Brain Stimulation that suggests that its NeuroStar TMS therapy can dramatically reduce the long-term need for antidepressants in individuals with major depressive disorder.

The impact of these three studies should be clear: In an era where controlling healthcare costs has taken on increased importance, regulators and reimbursement organizations need to take a hard look at total lifetime costs of drug therapies for neurological disorders when they compare them to neuromodulation therapies. And they need to factor in the secondary costs associated with addiction and illicit activity that result from our society’s overdependence on pharmaceuticals.

James Cavuoto

Editor and Publisher

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