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Started by jsaul
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In terms of price, you need to consider the cost of the electrodes ($750-2300 each) plus the price of the machine ($17,000-36,000) plus the price of the needles ($5-20 each). The least expensive machine is a used machine. I purchased a used N50 Stryker for $10,000 that includes 3 electrodes. The least expensive new machine is a Cosman ($17,000) followed by Owl (23,000). The new Neurotherm, Stryker, and SmithNephew are all around 28-32K while the Baylis is a bit higher. Radionics is theoretically available but Tyco killed the company and service on the machines is extremely difficult to find. Radionics is the only company to date that has multiple multiple reports to the FDA about injuries or problems occuring with their machine, but they have been in business a very long time. Stryker has the only electrode that is flexible and can be tied into knots without breaking ($2300) but should last much longer than other electrodes.
The electrodes need to be matched to the machines and are not fungible.
As for operating frequencies: all operate at 460-500kHz except the Owl (Canadian) that operates at 100kHz that puts it at a theoretical disadvantage if you believe the work of Albers on frequency vs pain production.
Regarding bells and whistles, none of the current machines do multipolar (several burns simultaneously) but there are several companies that will have that capability within months. It is a time saving device, but requires multiple electrodes in order to use this option (can be expensive). Many have IDET (virtually dead in the US), some have disctrode (virtually dead in the US), and all have pulsed RF in one form or another.
Neurotherm, Radionics, and Cosman have only low temperature pulsed RF available (~42 degrees) whereas the others have high temp pulse (may be useful in the future or for other applications).
In negotiating price, the companies have some latitude on the up front selling price of the machine and will make up the difference selling needles and electrodes. If you have a large Medicare population, buy a machine for your office. If your Medicare population is small, then there is no advantage for you to make the expenditure for your office. Medicare pays a physician approximately $750 for a 3-level lumbar z-joint RF in the office and 1/3 of that amount in an ASC or hospital.
The electrodes need to be matched to the machines and are not fungible.
As for operating frequencies: all operate at 460-500kHz except the Owl (Canadian) that operates at 100kHz that puts it at a theoretical disadvantage if you believe the work of Albers on frequency vs pain production.
Regarding bells and whistles, none of the current machines do multipolar (several burns simultaneously) but there are several companies that will have that capability within months. It is a time saving device, but requires multiple electrodes in order to use this option (can be expensive). Many have IDET (virtually dead in the US), some have disctrode (virtually dead in the US), and all have pulsed RF in one form or another.
Neurotherm, Radionics, and Cosman have only low temperature pulsed RF available (~42 degrees) whereas the others have high temp pulse (may be useful in the future or for other applications).
In negotiating price, the companies have some latitude on the up front selling price of the machine and will make up the difference selling needles and electrodes. If you have a large Medicare population, buy a machine for your office. If your Medicare population is small, then there is no advantage for you to make the expenditure for your office. Medicare pays a physician approximately $750 for a 3-level lumbar z-joint RF in the office and 1/3 of that amount in an ASC or hospital.
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Medicare does this as a cost containment method. Effectively, they are taking the line that they will pay only a certain amount of $$ for a procedure and how the physician elects to divide this up, is up to the physician. In actuality hospitals make a bit more than surgery centers for RF, but the physicians get screwed no matter what. Some of the major carriers are implementing the same site of service differential pricing structure (Anthem Blue Cross) and I expect many others will follow. It is one way to force procedures into doctors offices with the doctor assuming the increased risk of liability if anything goes wrong. It also cuts the costs to the insurer by 30-80%.
I found them on the FDA adverse events reporting site. The search is laborious and has to be done piecemeal. I will see if I can find a file I created on the subject....drop me a line at [email protected] and I will try to send the list to you.
Try the following link. It has the info I pulled off multiple years of FDA adverse events reports from 1992-2005
http://algosresearch.org/Education/OriginalArticles/RF_Adverse_Events_1992to2005.doc
http://algosresearch.org/Education/OriginalArticles/RF_Adverse_Events_1992to2005.doc
