Cost-effectiveness analysis of non-invasive vagus nerve stimulation for the treatment of chronic cluster headache

Abstract

BackgroundCluster headache (CH) is a debilitating condition that is generally associated with substantial health care costs. Few therapies are approved for abortive or prophylactic treatment. Results from the prospective, randomised, open-label PREVA study suggested that adjunctive treatment with a novel non-invasive vagus nerve stimulation (nVNS) device led to decreased attack frequency and abortive medication use in patients with chronic CH (cCH). Herein, we evaluate whether nVNS is cost-effective compared with the current standard of care (SoC) for cCH.MethodsA pharmacoeconomic model from the German statutory health insurance perspective was developed to estimate the 1-year cost-effectiveness of nVNS + SoC (versus SoC alone) using data from PREVA. Short-term treatment response data were taken from the clinical trial; longer-term response was modelled under scenarios of response maintenance, constant rate of response loss, and diminishing rate of response loss. Health-related quality of life was estimated by modelling EQ-5D™ data from PREVA; benefits were defined as quality-adjusted life-years (QALY). Abortive medication use data from PREVA, along with costs for the nVNS device and abortive therapies (i.e. intranasal zolmitriptan, subcutaneous sumatriptan, and inhaled oxygen), were used to assess health care costs in the German setting.ResultsThe analysis resulted in mean expected yearly costs of €7096.69 for nVNS + SoC and €7511.35 for SoC alone and mean QALY of 0.607 for nVNS + SoC and 0.522 for SoC alone, suggesting that nVNS generates greater health benefits for lower overall cost. Abortive medication costs were 23 % lower with nVNS + SoC than with SoC alone. In the alternative scenarios (i.e. constant rate of response loss and diminishing rate of response loss), nVNS + SoC was more effective and cost saving than SoC alone.ConclusionsIn all scenarios modelled from a German perspective, nVNS was cost-effective compared with current SoC, which suggests that adjunctive nVNS therapy provides economic benefits in the treatment of cCH. Notably, the current analysis included only costs associated with abortive treatments. Treatment with nVNS will likely promote further economic benefit when other potential sources of cost savings (e.g. reduced frequency of clinic visits) are considered.Trial registrationClinicaltrials.gov identifier NCT01701245, 03OCT2012.

Evidence of activation of vagal afferents by non-invasive vagus nerve stimulation: An electrophysiological study in healthy volunteers

“…Vagus nerve stimulation has been considered to be a valuable therapeutic option for neurologic diseases, but its use has been limited by the need for invasive surgical procedures ( 28 ). The viability of non-invasive methods for stimulating the vagus nerve using portable devices that are more practical, convenient, and cost effective (versus iVNS) has expanded the therapeutic potential of VNS for a larger patient population and improved its accessibility for use in further studies ( 28 , 29 ). In our study, we observed that further increases in stimulation intensity beyond 15 V only slightly increased the responder rate and produced only a slight increase in the size of the response ( Figure 3 ).…”

Cost impact of a non-invasive, portable device for patient self-administration of chronic migraine in a UK National Health Service setting

“…A US analysis calculated annual cost related to Botox treatment of 4902 US $, which is higher compared to both the individual funding request setting as well as the time-based average cost setting (Rothrock 2011 ). A German economic analysis of chronic cluster headache treatment assessed a comparable cost decrement of €414 for a non-invasive neuromodulatory technique in addition to standard of care (Morris et al 2016 ). .…”

Therapeutic strategies that act on the peripheral nervous system in primary headache disorders

“…The VNS treatment was superior to sham in ECH but not in CCH [109]. Regarding the economic aspect, the cost-effectiveness of the non-invasive VNS (the gammaCore® device) for the acute treatment of both ECH and CCH was superior to the standard of care [110,111].…”