The cost-effectiveness of spinal cord stimulation in the treatment of failed back surgery syndrome.
OBJECTIVE
Healthcare policy makers and payers require cost-effectiveness evidence to inform their treatment funding decisions. Thus, in 2008, the United Kingdom's National Institute of Health and Clinical Excellence analyzed the cost effectiveness of spinal cord stimulation (SCS) compared with conventional medical management (CMM) and with reoperation and recommended approval of SCS in selected patients with failed back surgery syndrome (FBSS). We present previously unavailable details of the National Institute of Health and Clinical Excellence analysis and an analysis of the impact on SCS cost effectiveness of rechargeable implanted pulse generators (IPGs).


METHODS
We used a decision analytic model to examine the cost effectiveness of SCS versus CMM and versus reoperation in patients with FBSS. We also modeled the impact of nonrechargeable versus rechargeable IPGs.


RESULTS
The incremental cost-effectiveness of SCS compared with CMM was pound5624 per quality-adjusted life year, with 89% probability that SCS is cost effective at a willingness to pay threshold of pound20,000. Compared with reoperation, the incremental cost-effectiveness of SCS was pound6392 per quality-adjusted life year, with 82% probability of cost-effectiveness at the pound20,000 threshold. When the longevity of an IPG is 4 years or less, a rechargeable (and initially more expensive) IPG is more cost-effective than a nonrechargeable IPG.


CONCLUSIONS
In selected patients with FBSS, SCS is cost effective both as an adjunct to CMM and as an alternative to reoperation. Despite their initial increased expense, rechargeable IPGs should be considered when IPG longevity is likely to be short.
Taylor
Rod S
RS
Peninsula Medical School, Universities of Exeter and Plymouth, UK.
Ryan
James
J
O'Donnell
Ruairi
R
Eldabe
Sam
S
Kumar
Krishna
K
North
Richard B
RB
D019567:Back Injuries / Q000601:surgery / Q000628:therapy*; D003362:Cost-Benefit Analysis / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005102:Health Expenditures; D006801:Humans; D015233:Models, Statistical; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010147:Pain Measurement; D011336:Probability; D011788:Quality of Life; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D006113:United Kingdom