Treatment of chronic pain with spinal cord stimulation versus alternative therapies: cost-effectiveness analysis.
OBJECTIVE
There is limited available research measuring the cost-effectiveness of spinal cord stimulation (SCS), compared with best medical treatment/conventional pain therapy (CPT). The purpose of this study was to tabulate the actual costs (in Canadian dollars) for a consecutive series of patients treated with SCS in a constant health care delivery environment and to compare the costs with those for a control group treated in the same controlled environment.


METHODS
We present a consecutive series of 104 patients with failed back syndrome. Within this group, 60 patients underwent SCS electrode implantation, whereas 44 patients were designated as control subjects. We monitored these patients for a 5-year period and tabulated the actual costs incurred in diagnostic imaging, professional fees paid to physicians, implantation (including the costs for hardware), nursing visits for maintenance of the stimulators, physiotherapy, chiropractic treatments, massage therapy, and hospitalization for treatment of breakthrough pain. From these data, the cumulative costs for each group were calculated for a 5-year period. An analysis of Oswestry questionnaire results was also performed, to evaluate the effects of treatment on the quality of life.


RESULTS
The actual mean cumulative cost for SCS therapy for a 5-year period was $29,123/patient, compared with $38,029 for CPT. The cost of treatment for the SCS group was greater than that for the CPT group in the first 2.5 years. The costs of treating patients with SCS became less than those for CPT after that period and remained so during the rest of the follow-up period. In addition, 15% of SCS-treated patients were able to return to employment, because of superior pain control and lower drug intake. No patients in the control group were able to return to employment of any kind.


CONCLUSIONS
SCS is cost-effective in the long term, despite the initial high costs of the implantable devices.
Department of Surgery, Regina General Hospital, University of Saskatchewan, Canada. K.Kumar@sk.sympatico.ca
Krishna
K
Kumar
Samaad
S
Malik
Denny
D
Demeria
D001416:Back Pain / Q000503:physiopathology / Q000628:therapy*; D002170:Canada; D002908:Chronic Disease; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D004599:Electric Stimulation Therapy / Q000191:economics*; D004567:Electrodes, Implanted / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D018710:Pain Clinics / Q000191:economics; D010148:Intractable Pain / Q000503:physiopathology / Q000628:therapy*; D010149:Postoperative Pain / Q000503:physiopathology / Q000628:therapy; D013116:Spinal Cord / Q000503:physiopathology*; D017211:Treatment Failure