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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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