Cost and Complication Profile of Targeted Muscle Reinnervation

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Background: Targeted muscle reinnervation (TMR) has emerged as a potentially effective strategy for the management of chronic limb pain in amputation patients. Despite its increasing adoption, a paucity of data exists regarding the complications and associated costs of TMR versus traditional amputation. This study compares the costs and complication profiles of patients who underwent amputation with immediate TMR (within 6 wk) versus amputation alone. Methods: The IQVIA PharMetrics Plus for Academics database was used for this study, with patients stratified into 2 groups depending on the addition of TMR to the amputation. Costs and complication profiles were compared between groups. Results: A total of 5643 patients underwent upper or lower extremity amputation, with 53 (0.94%) patients undergoing concomitant TMR. There was no significant difference in complication rates between patients undergoing TMR versus traditional amputation (67.9% versus 70.1%; P = 0.725). Overall costs between TMR and traditional amputation were not significantly different at 1 year between groups ($37,345 versus $39,359; P = 0.67). TMR was not associated with increased cost in the linear regression model ( P = 0.409). Conclusions: Our data suggest that performing TMR does not result in increased costs or a higher rate of complications. Broader use of TMR can provide potential long-term cost savings via reduced medication usage, improved ambulation, and better prosthetic use. Larger, randomized studies are needed to further verify the cost benefit of TMR as a therapeutic strategy, with the goal of broader implementation as a standard of care.

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