Assessment of economic effectiveness in treatment of neuropathic pain and refractory angina pectoris using spinal cord stimulation.
BACKGROUND
The implementation of new diagnostic and therapeutic technologies is related to expanding financial needs. The escalation of expenses for health protection and simultaneous economic problems has resulted in an interest in the subject of economic assessment. Decision makers in the health sector should have reasonable tools that will allow them to make complex evaluations of the economic suitability of health technologies. Economic analysis should also prove that launching new procedures can save money. Numerous studies indicate that chronic pain and psycho-sociological variables lead to a worse quality of life. Chronic pain issues are a major public health problem, by virtue of the difficulties in efficient therapy and the social costs reflected in incapability of work and disability. Spinal cord stimulation is the most efficacious procedure in the treatment of chronic pain.


OBJECTIVE
The aim of the study was to estimate the costs of treatment of 37 patients suffering from refractory angina pectoris and neuropathic pain who underwent SCS surgery between 2002 and 2008 in the Neurosurgery Clinic of the 10th Military Hospital in Bydgoszcz in the period of two years before and two years after spinal cord stimulation. The authors also assessed quality of life, using the SF 36 questionnaire, and degree of pain using VAS.


METHODS
The issue was examined with a cost-benefit analysis. Cost was understood as the expenses made two years before and two years after the SCS procedure. The benefits were health care expenses saved by implementation of the SCS procedure. All the costs included in both alternative treatment techniques in a period of 5 years underwent a discounting procedure. The authors also included the price of the neurostimulator under a sensitivity analysis. To assess the quality of life before and after the SCS procedure, a SF 36 questionnaire was used, and to assess the level of pain before and after the SCS procedure, the VAS scale.


RESULTS
The costs of treatment of refractory angina pectoris and neuropathic pain are lower when using spinal cord stimulation. In the case of refractory angina pectoris, savings reached 46% whereas in the case of neuropathic pain, 13.2%. The costs of the purchase of the device returned in three years for angina pectoris and seven years for neuropathic pain. SCS in both cases brought a reduction of the level of pain and an improvement to quality of life.


CONCLUSIONS
SCS in both neuropathic pain and refractory angina pectoris is a procedure that brings benefits in the form of savings. After using SCS in both cases, the quality of life improved and the level of pain was reduced.
Department of Preventive Medicine and Environmental Health, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Poland. ola.harat@cm.umk.pl
Aleksandra
A
Harat
Paweł
P
Sokal
Piotr
P
Zieliński
Marek
M
Harat
Teresa
T
Rusicka
Leszek
L
Herbowski
D000787:Angina Pectoris / Q000175:diagnosis / Q000191:economics / Q000523:psychology / Q000628:therapy*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D018803:Models, Economic; D009437:Neuralgia / Q000175:diagnosis / Q000191:economics / Q000523:psychology / Q000628:therapy*; D010147:Pain Measurement; D011044:Poland; D011788:Quality of Life; D012720:Severity of Illness Index; D062187:Spinal Cord Stimulation / Q000191:economics* / Q000295:instrumentation; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome