Disparities in the Use of Sacral Neuromodulation among Medicare Beneficiaries

Melissa A. Laudano, Stephan Seklehner, Jaspreet Sandhu, W. Stuart Reynolds, Kelly A. Garrett, Jeffrey W. Milsom, Alexis E. Te, Steven A. Kaplan, Bilal Chughtai, Richard K. Lee

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Purpose Sacral neuromodulation with the InterStim® has been done to treat urinary and bowel control. There are limited data in the literature on use trends of sacral neuromodulation. We explored disparities in use among Medicare beneficiaries. Materials and Methods We queried a 5% national random sample of Medicare claims for 2001, 2004, 2007 and 2010. All patients with an ICD-9 diagnosis code representing a potential urological indication for sacral neuromodulation were included. Patients who underwent device implantation were identified using CPT-4 codes. Statistical analysis was done with the chi-square and Fisher tests, and multivariate logistic regression using software. Results A total of 2,322,060 patients were identified with a diagnosis that could potentially be treated with sacral neuromodulation. During the 10-year study period the percent of these patients who ultimately underwent implantation increased from 0.03% to 0.91% (p <0.0001) for a total of 13,360 (0.58%). On logistic regression analysis women (OR 3.85, p <0.0001) and patients younger than 65 years (OR 1.00 vs 0.29 to 0.39, p <0.0001) were more likely to be treated. Minority patients (OR 0.38, p <0.0001) and those living in the western United States (OR 0.52, p <0.0001) were less likely to receive treatment. Conclusions Sacral neuromodulation use significantly increased among Medicare beneficiaries in a 10-year period. Patients were more likely to be treated with sacral neuromodulation if they were female, white, younger (younger than 65 years) and living outside the western United States.

Original languageEnglish (US)
Pages (from-to)449-453
Number of pages5
JournalJournal of Urology
Issue number2
StatePublished - Jan 1 2015
Externally publishedYes


  • Medicare
  • electric stimulation
  • fecal incontinence
  • lower urinary tract symptoms
  • urinary bladder

ASJC Scopus subject areas

  • Urology


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