Impact of spinal cord stimulation on healthcare utilization and costs in complex regional pain syndrome: analysis of South Korea’s National Health Insurance claims data

Background: Long-term economic impact of spinal cord stimulation (SCS) in Korea remains limited. This retrospective observational study evaluated healthcare utilization and costs associated with SCS in patients with complex regional pain syndrome (CRPS). Methods: Using claims data from South Korea's National Health Insurance Sharing Service (NHISS), we identified patients with CRPS who underwent trial or permanent SCS between 2005 and 2015. Patients were categorized into an SCS (permanent implantation) and a non-SCS (trial only) groups. Healthcare utilization and costs were analyzed over a one-year period before and after the index date. Results: The non-SCS group demonstrated a statistically significant increase in total hospitalization days (from 6.9 ± 22.6 to 17.0 ± 54.5, P = 0.02) and mean length of stay (from 2.6 ± 5.6 to 6.0 ± 17.5, P = 0.01). In contrast, the SCS group showed no significant changes in these hospitalization metrics. Between-group comparisons demonstrated significant differences in changes in hospitalization days and length of stay (P = 0.02). In addition, total healthcare costs increased significantly in the non-SCS group (from USD 2,448 ± 5,162 to USD 3,527 ± 6,943, P = 0.03), whereas no significant change was observed in the SCS group. Conclusions: SCS was associated with more favorable short-term healthcare utilization patterns, including stable hospitalization metrics and reduced procedure-related costs, compared with trial-only patients with CRPS. However, causal interpretation is limited by the observational design and residual confounding. These findings suggest a potential role of SCS in modifying healthcare utilization trajectories among patients with refractory CRPS.