Economic evaluation of spinal cord stimulation for chronic reflex sympathetic dystrophy.
OBJECTIVE
To evaluate the economic aspects of treatment of chronic reflex sympathetic dystrophy (RSD) with spinal cord stimulation (SCS), using outcomes and costs of care before and after the start of treatment.


METHODS
Fifty-four patients with chronic RSD were randomized to receive either SCS together with physical therapy (SCS+PT; n = 36) or physical therapy alone (PT; n = 18). Twenty-four SCS+PT patients responded positively to trial stimulation and underwent SCS implantation. During 12 months of follow-up, costs (routine RSD costs, SCS costs, out-of-pocket costs) and effects (pain relief by visual analogue scale, health-related quality of life [HRQL] improvement by EQ-5D) were assessed in both groups. Analyses were carried out up to 1 year and up to the expected time of death.


RESULTS
SCS was both more effective and less costly than the standard treatment protocol. As a result of high initial costs of SCS, in the first year, the treatment per patient is $4,000 more than control therapy. However, in the lifetime analysis, SCS per patient is $60,000 cheaper than control therapy. In addition, at 12 months, SCS resulted in pain relief (SCS+PT [-2.7] vs PT [0.4] [p < 0.001]) and improved HRQL (SCS+PT [0.22] vs PT [0.03] [p = 0.004]).


CONCLUSIONS
The authors found SCS to be both more effective and less expensive as compared with the standard treatment protocol for chronic RSD.
Kemler
Marius A
MA
Department of Surgery, Maastricht University Hospital, Maastricht, The Netherlands. kemlerm@mzh.nl
Furnée
Carina A
CA
D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006302:Health Services Research / Q000191:economics*; D006801:Humans; D016014:Linear Models; D008297:Male; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data; D011788:Quality of Life; D012019:Reflex Sympathetic Dystrophy / Q000191:economics* / Q000628:therapy*; D013116:Spinal Cord; D016896:Treatment Outcome