Developing Good Cash Prices for Peripheral Nerve Blocks
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you PRP nerves?
I get the feeling that some regenerative docs would PRP a dead horse if someone pays...
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Equine Vet J.
2024 Sep;56(5):858-869.
doi: 10.1111/evj.14042. Epub 2024 Jan 7.
A systematic review and meta-analysis of the efficacy of platelet-rich plasma products for treatment of equine joint disease
Cong Peng <a title="Equine Clinical Diagnostic Center, College of Veterinary Medicine, China Agricultural University, Beijing, China." href="A systematic review and meta-analysis of the efficacy of platelet-rich plasma products for treatment of equine joint disease - PubMed">1</a>, Luo Yang <a title="Equine Clinical Diagnostic Center, College of Veterinary Medicine, China Agricultural University, Beijing, China." href="A systematic review and meta-analysis of the efficacy of platelet-rich plasma products for treatment of equine joint disease - PubMed">1</a>, Raphael Labens <a title="School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Bathurst, New South Wales, Australia." href="A systematic review and meta-analysis of the efficacy of platelet-rich plasma products for treatment of equine joint disease - PubMed">2</a>, Yu Gao <a title="University of Veterinary Medicine Hannover, Hanover, Lower Saxony, Germany." href="A systematic review and meta-analysis of the efficacy of platelet-rich plasma products for treatment of equine joint disease - PubMed">3</a>, Yiping Zhu <a title="Equine Clinical Diagnostic Center, College of Veterinary Medicine, China Agricultural University, Beijing, China." href="A systematic review and meta-analysis of the efficacy of platelet-rich plasma products for treatment of equine joint disease - PubMed">1</a>, Jing Li <a title="Equine Clinical Diagnostic Center, College of Veterinary Medicine, China Agricultural University, Beijing, China." href="A systematic review and meta-analysis of the efficacy of platelet-rich plasma products for treatment of equine joint disease - PubMed">1</a> <a title="China Agricultural University Veterinary Teaching Hospital, Beijing, China." href="A systematic review and meta-analysis of the efficacy of platelet-rich plasma products for treatment of equine joint disease - PubMed">4</a>Affiliations Expand
- PMID: 38185481
- DOI: 10.1111/evj.14042
Abstract
Background: Equine joint disease including septic arthritis (SA) and osteoarthritis (OA) is a critical cause of equine lameness. Platelet-rich plasma (PRP) is one of the most popular regenerative therapies to treat equine OA, even SA, but the evidence in support of the treatment is conflicting.Objectives: The aim of the study was to systematically review the current evidence on PRP products used for SA and OA, as well as the efficacy of PRP products as treatment for OA on the basis of a meta-analysis of the available literature.
Study design: Systematic review and meta-analysis.
Methods: A systematic search of relevant databases (PubMed, Web of Science, Scopus) was performed to identify studies published from 2013 to 2023, in accordance with the PRISMA guidelines. Randomised controlled trials, non-randomised trials and controlled laboratory studies that used at least one type of PRP products were included. Dichotomous outcomes were presented using odds ratios (ORs) and 95% confidence intervals (95% CIs).
Results: A total of 21 publications were identified in the systematic review and 5 of them in the meta-analysis. These publications involved various types of PRP products and reported different outcomes. Although most of the studies were associated with a high risk of bias, the overall estimated effect was consistent with a significant improvement in the PRP products treatment group compared with the control group (OR: 15.32; 95% CI: 3.00-78.15; p < 0.05). There was a significant improvement in clinical performance outcomes between the groups (OR: 36.64; 95% CI: 3.69-364.30; p < 0.05).
Conclusion: PRP products as intra-articular treatment are likely efficacious for treatment of equine OA and have potential for treating SA. These conclusions might be affected by the limited number of randomised controlled studies and high variability of different types of PRP products. To better evaluate the efficacy of PRP, a widely recognised classification system and the utilisation of randomised, blinded, equivalency or non-inferiority trials are required.
Keywords: equine joint disease; horse; meta‐analysis; platelet‐rich plasma; treatment.
Efficacy of Platelet-rich Plasma Versus Steroid Injections in Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis (P5-7.010)
Ahmed Fathallah, Ibrahim Kamal, Mohamed Mamdouh, Mohamed Ahmed Ali, Esraa Ragaey, Abdulrahman Hagrass, and Anas Zakarya NoureldenAuthors Info & AffiliationsApril 8, 2025 issue
104 (7_Supplement_1) 2774
https://doi.org/10.1212/WNL.0000000000210577
Abstract
Objective:
This review compares the effectiveness of platelet-rich plasma (PRP) vs. steroids in improving symptoms and function in carpal tunnel syndrome (CTS).Background:
CTS is characterized by the compression of the median nerve as it traverses the carpal tunnel at the wrist. It manifests with pain, numbness, tingling, and weakness in the hand. Steroid injections lead to short-term improvement in CTS. PRP contains growth factors that promote tissue regeneration, with promising results in CTS.Design/Methods:
We searched Web of Science, Cochrane, PubMed, Scopus, and Embase for relevant articles till June 2024. We included RTCs and observational studies investigating steroids and PRP. The differences were presented as mean differences (MD) alongside 95% CI, after pooling studies using indirect meta-analysis assuming a random effects model.Results:
The review comprises 131 studies conducted over 9337 subjects. Both treatments significantly improved all parameters related to CTS. Studies measured the outcomes multiple times, and we subgrouped the measurements into <2-, 2–6-, and 6–12-months post-treatment to analyze trends in effects. There was no significant difference in BCTQ-S between both treatments up to six months. Beyond that, PRP was associated with a greater reduction in severity scores compared to steroids [−1.31 vs. −0.79; P=0.04). Effects on BCTQ-F exhibited no significant difference in the first two months. However, PRP patients had better function scores beyond that: 2–6 months (PRP: −1.11, Steroid: −0.77; P<0.00001) and 6–12 months (PRP: −1.17, Steroid: −0.46; P<0.00001). VAS scores for pain were significantly lower for PRP only after 6 months (PRP: −4.96, Steroid: −2.27; P=0.007). We observed no significant differences between both drugs in DML and SCNV across all three intervals.Conclusions:
Both steroids and PRP reduce the severity and improve the function in patients with CTS. PRP was superior in reducing pain and improving function in the long term, whereas steroid effects waned over time.
These all seem reasonable. I just did a cash pay for a genicular RFA because she has Medicare advantage. I think I charged 500. I should probably charge more.
Anybody have thoughts on the odds of these CPTs actually being gutted?
Dead animals require BMAC. PRP isn't magic.
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do you know if different docs within the same practice can have different charges?
Ortho docs in my group are planning to charge $500 (no kits used)
Which seems almost not worth while with drawing up blood, spinning, and then doing injection
Ortho docs in my group are planning to charge $500 (no kits used)
Which seems almost not worth while with drawing up blood, spinning, and then doing injection
When do we get a final ruling on whether these CPTs will not get paid by MCR? If these get cut, there is going to be A LOT more PNS happening.
Funny I literally did one of those phone consultation things with an I-bank company regarding PNS and I said yeah if they cut peripheral nerve blocks my PNS trial volume will likely goup dramatically lol
Bumping this thread, as it looks like all the peripheral nerve blocks are going away and we need to be ready with cash options.
drusso, I think your cash prices are very reasonable.
Right to SCS trial
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This is how a real market works.
You probably could charge more depending on the demographic you serve. How much more is debatable. Most physicians do not take into account market rates, liability, and total costs when doing these calculations. When you have chiro run clinics doing “stem cell injections” at the price of 10-20k by a nurse practitioner (to save patient costs of using a physician-is the explanation i have heard) and people are paying. It may give you perspective.
Agree. I would definitely charge 30% more for everything, 50% more if major metro.
We spent 13 years becoming trained and sacrificed a lot to become boarded specialist physicians.
one question on your prices.
why are you charging $600 for genicular RFA but $850 for peripheral nerve RFA?
seems like the amount of work you do and the equipment you need that you should charge similar rates for both. you already are charging more for genicular block than the other blocks.
why are you charging $600 for genicular RFA but $850 for peripheral nerve RFA?
seems like the amount of work you do and the equipment you need that you should charge similar rates for both. you already are charging more for genicular block than the other blocks.
