Cost-Effectiveness and Cost-Utility Analysis of Spinal Cord Stimulation in Patients With Failed Back Surgery Syndrome: Results From the PRECISE Study

Furio Zucco, Roberta Ciampichini, Angelo Lavano, Amedeo Costantini, Marisa De Rose, Paolo Poli, Gianpaolo Fortini, Laura Demartini, Enrico De Simone, Valentino Menardo, Piero Cisotto, Mario Meglio, Luciana Scalone, Lorenzo G. Mantovani

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective To assess the cost-effectiveness and cost-utility of Spinal Cord Stimulation (SCS) in patients with failed back surgery syndrome (FBSS) refractory to conventional medical management (CMM). Materials and Methods We conducted an observational, multicenter, longitudinal ambispective study, where patients with predominant leg pain refractory to CMM expecting to receive SCS+CMM were recruited in 9 Italian centers and followed up to 24 months after SCS. We collected data on clinical status (pain intensity, disability), Health-Related Quality-of-Life (HRQoL) and on direct and indirect costs before (pre-SCS) and after (post-SCS) the SCS intervention. Costs were quantified in € 2009, adopting the National Health Service's (NHS), patient and societal perspectives. Benefits and costs pre-SCS versus post-SCS were compared to estimate the incremental cost-effectiveness and cost utility ratios. Results 80 patients (40% male, mean age 58 years) were recruited. Between baseline and 24 months post-SCS, clinical outcomes and HRQoL significantly improved. The EQ-5D utility index increased from 0.421 to 0.630 (p <0.0001). Statistically significant improvement was first observed six months post-SCS. Societal costs increased from €6600 (pre-SCS) to €13,200 (post-SCS) per patient per year. Accordingly, the cost-utility acceptability curve suggested that if decision makers' willingness to pay per Quality-Adjusted-Life-Years (QALYs) was €60,000, SCS implantation would be cost-effective in 80% and 85% of cases, according to the NHS's and societal point of views, respectively. Conclusions Our results suggest that in clinical practice, SCS+CMM treatment of FBSS patients refractory to CMM provides good value for money. Further research is encouraged in the form of larger, long-term studies.

Original languageEnglish
Pages (from-to)266-276
Number of pages11
JournalNeuromodulation
Volume18
Issue number4
DOIs
Publication statusPublished - Jun 1 2015

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Failed Back Surgery Syndrome
Spinal Cord Stimulation
Cost-Benefit Analysis
Costs and Cost Analysis
Quality of Life
Intractable Pain

Keywords

  • Cost-effectiveness
  • cost-utility
  • failed back surgery syndrome
  • quality adjusted life years
  • Spinal Cord Stimulation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology

Cite this

Cost-Effectiveness and Cost-Utility Analysis of Spinal Cord Stimulation in Patients With Failed Back Surgery Syndrome : Results From the PRECISE Study. / Zucco, Furio; Ciampichini, Roberta; Lavano, Angelo; Costantini, Amedeo; De Rose, Marisa; Poli, Paolo; Fortini, Gianpaolo; Demartini, Laura; De Simone, Enrico; Menardo, Valentino; Cisotto, Piero; Meglio, Mario; Scalone, Luciana; Mantovani, Lorenzo G.

In: Neuromodulation, Vol. 18, No. 4, 01.06.2015, p. 266-276.

Research output: Contribution to journalArticle

Zucco, F, Ciampichini, R, Lavano, A, Costantini, A, De Rose, M, Poli, P, Fortini, G, Demartini, L, De Simone, E, Menardo, V, Cisotto, P, Meglio, M, Scalone, L & Mantovani, LG 2015, 'Cost-Effectiveness and Cost-Utility Analysis of Spinal Cord Stimulation in Patients With Failed Back Surgery Syndrome: Results From the PRECISE Study', Neuromodulation, vol. 18, no. 4, pp. 266-276. https://doi.org/10.1111/ner.12292
Zucco, Furio ; Ciampichini, Roberta ; Lavano, Angelo ; Costantini, Amedeo ; De Rose, Marisa ; Poli, Paolo ; Fortini, Gianpaolo ; Demartini, Laura ; De Simone, Enrico ; Menardo, Valentino ; Cisotto, Piero ; Meglio, Mario ; Scalone, Luciana ; Mantovani, Lorenzo G. / Cost-Effectiveness and Cost-Utility Analysis of Spinal Cord Stimulation in Patients With Failed Back Surgery Syndrome : Results From the PRECISE Study. In: Neuromodulation. 2015 ; Vol. 18, No. 4. pp. 266-276.
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abstract = "Objective To assess the cost-effectiveness and cost-utility of Spinal Cord Stimulation (SCS) in patients with failed back surgery syndrome (FBSS) refractory to conventional medical management (CMM). Materials and Methods We conducted an observational, multicenter, longitudinal ambispective study, where patients with predominant leg pain refractory to CMM expecting to receive SCS+CMM were recruited in 9 Italian centers and followed up to 24 months after SCS. We collected data on clinical status (pain intensity, disability), Health-Related Quality-of-Life (HRQoL) and on direct and indirect costs before (pre-SCS) and after (post-SCS) the SCS intervention. Costs were quantified in € 2009, adopting the National Health Service's (NHS), patient and societal perspectives. Benefits and costs pre-SCS versus post-SCS were compared to estimate the incremental cost-effectiveness and cost utility ratios. Results 80 patients (40{\%} male, mean age 58 years) were recruited. Between baseline and 24 months post-SCS, clinical outcomes and HRQoL significantly improved. The EQ-5D utility index increased from 0.421 to 0.630 (p <0.0001). Statistically significant improvement was first observed six months post-SCS. Societal costs increased from €6600 (pre-SCS) to €13,200 (post-SCS) per patient per year. Accordingly, the cost-utility acceptability curve suggested that if decision makers' willingness to pay per Quality-Adjusted-Life-Years (QALYs) was €60,000, SCS implantation would be cost-effective in 80{\%} and 85{\%} of cases, according to the NHS's and societal point of views, respectively. Conclusions Our results suggest that in clinical practice, SCS+CMM treatment of FBSS patients refractory to CMM provides good value for money. Further research is encouraged in the form of larger, long-term studies.",
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AU - Lavano, Angelo

AU - Costantini, Amedeo

AU - De Rose, Marisa

AU - Poli, Paolo

AU - Fortini, Gianpaolo

AU - Demartini, Laura

AU - De Simone, Enrico

AU - Menardo, Valentino

AU - Cisotto, Piero

AU - Meglio, Mario

AU - Scalone, Luciana

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