Spinal cord stimulation for failed back surgery syndrome: a decision-analytic model and cost-effectiveness analysis

Area of Science:

• Health Economics
• Clinical Outcomes Research
• Pain Management

Background:

• Failed back surgery syndrome (FBSS) presents a significant challenge in pain management.
• Conventional medical management (CMM) offers limited relief for many FBSS patients.
• Spinal cord stimulation (SCS) is an alternative treatment option requiring cost-effectiveness evaluation.

Purpose of the Study:

• To develop a decision-analytic model assessing the cost-effectiveness of SCS versus CMM for FBSS.
• To synthesize evidence on healthcare costs and patient outcomes for both treatment strategies.

Main Methods:

• A decision tree and Markov model were employed to analyze data from two randomized controlled trials (RCTs).
• Outcomes were measured as pain relief levels over a 2-year follow-up period.
• Health-care costs were derived from a Canadian costing study, with results presented as incremental cost per Quality Adjusted Life Year (QALY) in 2003 Euros.

Main Results:

• Over a patient's lifetime, SCS was found to be dominant, offering greater health gain and cost savings compared to CMM.
• This finding remained robust across various sensitivity analyses.
• In the short-term (2-year horizon), SCS demonstrated increased health gain but incurred higher costs, with cost-effectiveness ranging from 30,370 to 63,511 Euros.

Conclusions:

• Spinal cord stimulation (SCS) is a more effective and less costly treatment option than conventional medical management (CMM) for failed back surgery syndrome (FBSS) in the long term.
• While potentially cost-effective in the short term, SCS results are sensitive to input parameters.
• Further empirical data are needed to enhance the precision of short-term cost-effectiveness estimations.