Occipital Nerve Stimulation for Refractory Chronic Cluster Headache: A Cost-Effectiveness Study

Area of Science:

• Neurology
• Health Economics
• Medical Technology Assessment

Background:

• Refractory chronic cluster headache (rCCH) poses a significant challenge, with limited treatment options.
• Occipital nerve stimulation (ONS) is a proposed therapy for rCCH, but its economic viability remains unevaluated.
• Lack of cost-effectiveness data hinders ONS adoption and insurance coverage.

Purpose of the Study:

• To evaluate the cost-effectiveness of ONS in treating rCCH.
• To compare ONS combined with conventional treatment against conventional treatment alone.
• To assess the impact of ONS on indirect costs, such as sick leave.

Main Methods:

• A prospective, before-and-after economic study using a nationwide registry.
• Analysis of 76 rCCH patients from a French healthcare perspective.
• Cost-effectiveness evaluation at three months and one year (extrapolated), including indirect costs.

Main Results:

• At three months, ONS incurred higher costs (€7602) with a small gain in quality-adjusted life-years (QALYs), yielding an ICER of €109,676/QALY.
• By one year, ONS strategy was associated with lower costs (€1344) and a significant gain in QALYs (0.28), resulting in a dominant ICER (€-4846/QALY).
• Probabilistic bootstrapping indicated ONS dominance in 80% of replications; indirect costs were also lower with ONS at three months (€377).

Conclusions:

• Short-term economic studies may inaccurately dismiss innovative treatments like ONS.
• A one-year extrapolation demonstrates ONS as a dominant and cost-effective strategy for rCCH.
• The cost-effectiveness and dominance of ONS support its wider adoption, validation, and reimbursement for rCCH patients.