title: Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: an observational study in a workers' compensation population.
abstract: METHODS
  Prospective cohort study.
  
  
  OBJECTIVE
  We estimated the cost-effectiveness of spinal cord stimulation (SCS) among workers' compensation recipients with failed back surgery syndrome (FBSS).
  
  
  BACKGROUND
  Randomized controlled trial (RCT) evidence suggests that SCS is more effective at 6 months than medical management for patients with FBSS. However, procedure costs are high and workers' compensation claimants often have worse outcomes than other patients.
  
  
  METHODS
  We enrolled 158 FBSS patients receiving workers' compensation into three treatment groups: trial SCS with or without permanent device implant (n = 51), pain clinic (PC) evaluation with or without treatment (n = 39), and usual care (UC; n = 68). The primary outcome was a composite measure of pain, disability and opioid medication use. As reported previously, 5% of SCS patients, 3% of PC patients and 10% of UC patients achieved the primary outcome at 24 months. Using cost data from administrative databases, we calculated the cost-effectiveness of SCS, adjusting for baseline covariates.
  
  
  RESULTS
  Mean medical cost per SCS patient over 24 months was $52,091. This was $17,291 (95% confidence intervals [CI], $4100-30,490) higher than in the PC group and $28,128 ($17,620-38,630) higher than in the UC group. Adjusting for baseline covariates, the mean total medical and productivity loss costs per patient of the SCS group were $20,074 ($3840-35,990) higher than those of the PC group and $29,358 ($16,070-43,790) higher than those of the UC group. SCS was very unlikely (<5% probability) to be the most cost-effective intervention.
  
  
  CONCLUSIONS
  In this sample of workers' compensation recipients, the high procedure cost of SCS was not counterbalanced by lower costs of subsequent care, and SCS was not cost-effective. The benefits and potential cost savings reported in RCTs may not be replicated in workers' compensation patients treated in community settings.
authors: Department of Social Medicine, University of Bristol, Bristol, England. william.hollingworth@bristol.ac.uk
authors: William
authors: W
authors: Hollingworth
authors: Judith A
authors: JA
authors: Turner
authors: Nicky J
authors: NJ
authors: Welton
authors: Bryan A
authors: BA
authors: Comstock
authors: Richard A
authors: RA
authors: Deyo
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D004599:Electric Stimulation Therapy / Q000191:economics / Q000379:methods*; D055111:Failed Back Surgery Syndrome / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic / Q000191:economics; D013116:Spinal Cord / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014942:Workers' Compensation / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult