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Published on: February 10, 2011
Cost-effectiveness of Traditional and Multimodal Spinal Cord Stimulation Systems Compared With Conventional Medical
Anna Gustafsson1, Emelie Andersson1, Adam Fridhammar1
1The Swedish Institute for Health Economics, Lund, Sweden.
Objectives:
This study evaluates the cost-effectiveness of rechargeable (RC) and nonrechargeable, primary cell (PC) traditional and multimodal spinal cord stimulation (SCS) systems in combination with conventional medical management (CMM) compared with CMM alone in patients with persistent spinal pain syndrome type 2 (PSPS-2) with low back/leg pain that remains despite surgery.
Material And Methods:
A state-transition Markov model was developed to estimate costs and quality-adjusted life years (QALYs) over a 15-year time horizon. Clinical effectiveness and utility inputs were derived from published literature and clinical trials, whereas cost data were obtained from health care registries. A lifespan of 15 years for the RC system and five years for the PC system was assumed. Parameter uncertainty was tested using both deterministic and probabilistic sensitivity analyses.
Results:
Over the lifespan of the model, SCS was associated with a €674 reduction in drug-related costs and a €206 reduction in nondrug therapy costs compared with CMM alone. The SCS group accumulated an additional 2.173 QALYs per patient over the same period, yielding incremental cost-effectiveness ratios (ICERs) of €10,313 per QALY gained for the RC system and €13,393 per QALY gained for the PC system. Scenario analyses indicated that recent technologic advancements, such as the implementation of multimodal stimulation, have improved the cost-effectiveness of SCS systems, particularly favoring RC devices. Sensitivity analyses indicated the robustness of the findings, with the ICERs ranging from €7700 per QALY to €15,000 per QALY for the RC and €10,000 per QALY to €20,100 per QALY for the PC system; the utility value for responders had the greatest impact.
Conclusions:
The results from this study show that use of multimodal stimulation can further improve the cost-effectiveness of traditional SCS in patients with PSPS-2. These findings support the broader adoption of advanced SCS technologies in routine clinical practice.
