title: Impact of the National Institute for Health and Care Excellence (NICE) guidance on medical technology uptake: analysis of the uptake of spinal cord stimulation in England 2008-2012.
abstract: BACKGROUND
  The National Institute for Health and Care Excellence (NICE) Technology Appraisal Guidance on spinal cord stimulation (SCS) was published in 2008 and updated in 2012 with no change. This guidance recommends SCS as a cost-effective treatment for patients with neuropathic pain.
  
  
  OBJECTIVE
  To assess the impact of NICE guidance by comparing SCS uptake in England pre-NICE (2008-2009) and post-NICE (2009-2012) guidance. We also compared the English SCS uptake rate with that of Belgium, the Netherlands, France and Germany.
  
  
  METHODS
  SCS implant data for England was obtained from the Hospital Episode Statistics (HES) database and compared with other European countries where comparable data were available.
  
  
  RESULTS
  The HES data showed small increases in SCS implantation and replacement/revision procedures, and a large increase in SCS trials between 2008 and 2012. The increase in the total number of SCS procedures per million of population in England is driven primarily by revision/replacements and increased trial activity. Marked variability in SCS uptake at both health regions and primary care trust level was observed.
  
  
  CONCLUSIONS
  Despite the positive NICE recommendation for the routine use of SCS, we found no evidence of a significant impact on SCS uptake in England. Rates of SCS implantation in England are lower than many other European countries.
authors.affiliation: Department of Pain and Anaesthesia, James Cook University Hospital, Middlesbrough, UK.
authors.forename: Bharati
authors.initials: B
authors.lastname: Vyawahare
authors.forename: Natalie
authors.initials: N
authors.lastname: Hallas
authors.forename: Morag
authors.initials: M
authors.lastname: Brookes
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.forename: Sam
authors.initials: S
authors.lastname: Eldabe
mesh_terms: D004739:England; D005060:Europe; D006801:Humans; D017410:Practice Guidelines as Topic; D062187:Spinal Cord Stimulation / Q000592:standards* / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: PAIN MANAGEMENT