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Key Paper Summaries Neurostimulation

Cost Effectiveness

Kumar K, Malik S, Demeria D
Treatment of chronic pain with spinal cord stimulation versus alternative therapies: cost effectiveness analysis. Neurosurgery 2002; 51: 106-16
Methods
  • Limited research is available measuring the cost-effectiveness of spinal cord stimulation (SCS) compared with the best medical treatment/conventional pain therapy (CPT). Thus, the purpose of this study was to evaluate the actual costs (Canadian dollars) for a consecutive series of patients treated with SCS compared with those for a control group treated in the same controlled environment.

  • From a total of 104 patients with failed back syndrome, 60 patients underwent SCS electrode implantation (with either Itrel II, Itrel III or X-trel, using either Resume or Pisces-Quad electrodes) and 44 patients were designated as control subjects and received CPT.

  • Patients were monitored for a 5-year period. The actual costs incurred in diagnostic imaging, professional fees paid to physicians, implantation (including costs for hardware), nursing visits for maintenance of the stimulators, physiotherapy, chiropractic treatments, massage therapy and hospitalization for treatment of breakthrough pain, were tabulated.

  • From these data, cumulative costs for each group were calculated for the 5-year period. An analysis of Oswestry questionnaire results was also performed, to evaluate the effects of treatment on the quality of life (QoL).

  • No attempt was made to attribute monetary values to degree of pain relief, QoL or benefits of return to work.
Results
  • The actual mean cumulative cost for SCS therapy for a 5-year period was lower at $29,123 per patient, compared with $38,029 for CPT.

  • Although the cost of treatment for the SCS group was greater that that for the CPT group in the first 2.5 years, the costs of treating patients with SCS became less than those for CPT after this period and remained so during the rest of the follow-up period.

  • Drug intake for pain was reduced in the SCS group. Preoperatively, the average cost of drug therapy was $78/month (calculated from patient records); postoperatively, the cost decreased to $25/month. The average pharmacotherapy cost for the control group was higher at $72/month.

  • Quality of life and return to work parameters were not included in the cost calculation but provided very interesting data. Results of the Oswestry questionnaire indicated a 27% improvement in QOL in the SCS group compared with 12% improvement in the CPT group. In addition, 15% of SCS-treated patients were able to return to employment because of superior pain control and lower drug intake. No patients in the CPT group were able to return to employment of any kind.
Discussion/conclusion
  • Patients with chronic pain secondary to failed back syndrome who respond to SCS therapy can achieve significant cost savings in the long term, despite the high initial costs of the implantable devices.

  • Additional benefits may also include an increased rate of work rehabilitation, increased pain control and a better quality of life. Such considerations would increase the advantage of SCS over conventional pain therapy.

  • Further cost savings could result from improvements in the effectiveness of SCS therapy, which might be achieved via more effective patient selection criteria and technological advances in the equipment use.
Bell GK, Kidd D, North RB
Cost-Effectiveness Analysis of Spinal Cord Stimulation in Treatment of Failed Back Surgery Syndrome. Journal of Pain and Symptom Management 1997; 13: 286-295
Methods
  • The aim of this study was to compare the cost-effectiveness of spinal cord stimulation (SCS) and alternative interventions for the treatment of failed back surgery syndrome (FBSS).

  • Estimates of medical costs were derived from a number of resources, including physician fees, clinical literature, expert opinion and Medtronic equipment costs.

  • The cost analysis model consisted of 2 identical patients with FBSS, each assumed to have at least one failed back surgery, and currently preparing to undergo another. One patient was assumed to carry on with standard chronic maintenance therapy, while the remaining patient underwent treatment with SCS.

  • The annual cost of therapy was estimated over a 5-year period for both patients.
    The cost for an externally powered SCS device (Medtronic's X-trel system) and an internally powered device (Medtronic's Itrel system) was considered separately.
Results
  • The value for 5 years of chronic maintenance therapy for a patient with FBSS was estimated at $76, 180 on a charge basis, or $45, 580 on a Medicare fee or cost basis.

  • For the internally powered SCS system, the value for 5 years of therapy was estimated at $75, 350 on a charge basis, ($46, 730 on a Medicare fee or cost basis) and $69, 730 on a charge basis ($43, 080 on a Medicare fee or cost basis) for the externally powered system.

  • Assuming a 5% real discount rate, the payback period for the internal SCS system was estimated at 4.7 years on a charge basis (5.5 years on a Medicare fee or cost basis) and 3.4 years on a charge basis (3.9 years on a Medicare fee or cost basis) for the external system.
Discussion/conclusion
  • This analysis indicates that SCS therapy, by reducing the demands for medical care made by FBSS patients, can lead to medical cost savings.

  • For those patients who respond well to SCS therapy, the system pays for itself within 2.1 years.


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