Spinal cord stimulation for failed back surgery syndrome: a decision-analytic model and cost-effectiveness analysis.
OBJECTIVE
The aim of this study was to develop a decision-analytic model to assess the cost-effectiveness of spinal cord stimulation (SCS), relative to nonsurgical conventional medical management (CMM), for patients with failed back surgery syndrome (FBSS).


METHODS
A decision tree and Markov model were developed to synthesize evidence on both health-care costs and outcomes for patients with FBSS. Outcome data of SCS and CMM were sourced from 2-year follow-up data of two randomized controlled trials (RCTs). Treatment effects were measured as levels of pain relief. Short- and long-term health-care costs were obtained from a detailed Canadian costing study in FBSS patients. Results are presented as incremental cost per quality adjusted life year (QALY) and expressed in 2003 Euros. Costs were discounted at 6 percent and outcomes at 1.5 percent.


RESULTS
Over the lifetime of the patient, SCS was dominant (i.e., SCS is cost-saving and gives more health gain relative to CMM); a finding that was robust across sensitivity analyses. At a 2-year time horizon, SCS gave more health gain but at an increased cost relative to CMM. Given the uncertainty in effectiveness and cost parameters, the 2-year cost-effectiveness of SCS ranged from 30,370 Euros in the base case to 63,511 Euros in the worst-case scenario.


CONCLUSIONS
SCS was found to be both more effective and less costly than CMM, over the lifetime of a patient. In the short-term, although SCS is potentially cost-effective, the model results are highly sensitive to the choice of input parameters. Further empirical data are required to improve the precision in the estimation of short-term cost-effectiveness.
Taylor
Rebecca J
RJ
University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. r.j.taylor@bham.ac.uk
Taylor
Rod S
RS
D002170:Canada; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004599:Electric Stimulation Therapy / Q000191:economics*; D005102:Health Expenditures; D006801:Humans; D017116:Low Back Pain / Q000209:etiology* / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013116:Spinal Cord; D017211:Treatment Failure