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Spinal cord stimulation for failed back surgery syndrome: A decision-analytic model and cost-effectiveness analysis

Published online by Cambridge University Press:  04 August 2005

Rebecca J. Taylor  and
Rod S. Taylor
Rebecca J. Taylor
Affiliation:
University of Birmingham
Rod S. Taylor
Affiliation:
University of Birmingham
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Abstract

Objectives: The aim of this study was to develop a decision-analytic model to assess the cost-effectiveness of spinal cord stimulation (SCS), relative to nonsurgical conventional medical management (CMM), for patients with failed back surgery syndrome (FBSS).

Methods: A decision tree and Markov model were developed to synthesize evidence on both health-care costs and outcomes for patients with FBSS. Outcome data of SCS and CMM were sourced from 2-year follow-up data of two randomized controlled trials (RCTs). Treatment effects were measured as levels of pain relief. Short- and long-term health-care costs were obtained from a detailed Canadian costing study in FBSS patients. Results are presented as incremental cost per quality adjusted life year (QALY) and expressed in 2003 Euros. Costs were discounted at 6 percent and outcomes at 1.5 percent.

Results: Over the lifetime of the patient, SCS was dominant (i.e., SCS is cost-saving and gives more health gain relative to CMM); a finding that was robust across sensitivity analyses. At a 2-year time horizon, SCS gave more health gain but at an increased cost relative to CMM. Given the uncertainty in effectiveness and cost parameters, the 2-year cost-effectiveness of SCS ranged from €30,370 in the base case to €63,511 in the worst-case scenario.

Conclusions: SCS was found to be both more effective and less costly than CMM, over the lifetime of a patient. In the short-term, although SCS is potentially cost-effective, the model results are highly sensitive to the choice of input parameters. Further empirical data are required to improve the precision in the estimation of short-term cost-effectiveness.

Keywords

Spinal cord stimulationCost-effectivenessDecision-analysisModeling
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 3 , July 2005 , pp. 351 - 358
Copyright
© 2005 Cambridge University Press

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References

Briggs A, Sculpher M. 1995 Sensivity analysis in economic evaluation of health care technologies: The role of senstivity analysis. Health Econ. 4: 355– 371.Google Scholar
Bucher H, Guyatt G, Griffith L, et al. 1997 The results of direct and indirect treatment comparisons in the meta-analysis of randomized controlled trials. J Clin Epidemiol. 50: 683– 691.Google Scholar
Burstrom K, Johannesson M, Diderichsen F. 2001 Swedish population health-related quality of life results using EQ-5D. Qual Life Res. 10: 621– 635.Google Scholar
Controlled Trials Register. A prospective, randomised, controlled, multicentre study to evaluate the effectiveness and cost-effectiveness of spinal cord stimulation using the Synergy System in reducing pain in patients with failed back surgery syndrome compared to conventional medical management (PROCESS study). ISRCTN77527324 Available at: http://www.controlled-trials.com/isrctn/. Accessed 5 September 2004.
De Lissovoy G, Brown Re, Halpern M, et al. 1997 Cost-effectiveness of long-term intrathecal morphine therapy for pain associated with failed back surgery syndrome. Clin Ther. 19: 96– 112.Google Scholar
Drummond M, Brown R, Fendrick MA, et al. 2003 Use of pharmacoeconomics information report of the ISPOR task force on use of pharmacoeconomic/health economic information in health-care decision making. Value Health. 6: 407– 416.Google Scholar
Fritzell P, Hagg O, Wessberg P, et al. 2001 Lumbar fusion versus nonsurgical treatment for chronic low back pain. Spine. 26: 2521– 2534.Google Scholar
Fryback DG, Dasback EJ, Klein R, et al. 1993 The Beaver Dam health outcomes study: Initial catalog of health-state quality factors. Med Decis Making. 13: 89– 102.Google Scholar
Garratt AM, Klaber MOFFET J, et al. 2001 Responsiveness of generic and specific measures of health outcome in low back pain. Spine. 26: 71– 77.Google Scholar
Hollingworth W, Dyo RA, Sullivan SD, et al. 2002 The practicality and validity of directly elicited and SF-36 derived health state preferences in patients with low back pain. Health Econ. 11: 71– 85.Google Scholar
Kemler MA, Barendse GA, van KLEEF M, et al. 2000 Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 343: 618– 624.Google Scholar
Kendrick D, Fielding K, Bentley E, et al. 2001 The role of radiography in primary care patients with low back pain of at least 6 weeks duration: A randomised controlled (unblinded) trial. Health Technol Assess. 5: 1– 69.Google Scholar
Kumar K, Malik S, Deneria D. 2002 Treatment of chronic pain with spinal cord stimulation versus alternative therapies: Cost-effectiveness analysis. Neurosurgery. 51: 106– 116.Google Scholar
Kuntz KM, Snider RK, Weinstein JN, et al. 2000 Cost-effectiveness of fusion with and without instrumentation for patients with degenerative spondylolisthesis and spinal stenosis. Spine. 25: 1132– 1139.Google Scholar
Kupers RC, Van DEN Oever R, Van HOUDENHOVE H, et al. 1994 Spinal cord stimulation in Belgium: A nation-wide survey on the incidence, indications and therapeutic efficacy by the health insurer. Pain. 56: 211– 216.Google Scholar
Malter A, Larson EB, Urban N, Deyo TA. 1996 Cost-effectiveness of lumbar discectomy for the treatment of herniated intervertebral disc. Spine. 21: 1048– 1055.Google Scholar
National Institute for Clinical Excellence. 2001 Guidance for manufacturers and sponsors. London: NICE; June.
North RB, Kidd DH, Lee MS. 1994 A prospective, randomized study of spinal cord stimulation versus reoperation for failed back surgery syndrome: Initial results. Stereotact Funct Neurosurg. 62: 267– 272.Google Scholar
North RB, Kidd DH, Lee MS. 1995 Spinal cord stimulation versus operation for failed back surgery syndrome: A prospective, randomized controlled trial. Acta Neurochir Suppl. 64: 106– 108.Google Scholar
North RB. 2000 Reoperation versus neuromodulation for failed back surgery. International Neuromodulation Society San Francisco, California, July 15,.
North RB, Kidd DH, Farrokhi F, Piantadosi SA. 2005 Spinal cord stimulation versus repeated lumbosacral operation for chronic pain: A randomized controlled trial. Spine. 64: 98– 107.Google Scholar
Raftery J. 2001 NICE: Faster access to modern treatments? Analysis of guidance on health technologies. BMJ. 323: 1300– 1303.Google Scholar
Song F, Altman DG, Glenny A-M, Deeks JJ. 2003 Validity of indirect comparison of competing interventions: Empirical evidence from published meta-analysis. BMJ. 326: 472.Google Scholar
Taylor RS, Taylor RJ, Van Buyten JP, Buchser E, North R, Bayliss S. 2004 The cost effectiveness of spinal cord stimulation in the treatment of pain: A systematic review of the literature. J Pain Symptom Manage. 27: 370– 378.Google Scholar
Taylor RS, Van Buyten J-P, Buchser E. 2005 Effectiveness of spinal cord stimulation in the management of failed back surgery syndrome: Systematic reviews and assessment of prognostic factors. Spine. 30: 152– 160.Google Scholar
Turner JA, Loeser JD, Deyo RA, Sanders SB. 2004 Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: A systematic review of effectiveness and complications. Pain. 108: 137– 147.Google Scholar