Real-World Cost-Effectiveness Analysis of Spinal Cord Stimulation vs Conventional Therapy in the Management of Failed Back Surgery Syndrome

Rojo, Elena; Hernández, Concepción Pérez; Martínez, Nathalie Tamayo; Margarit, Antoni; Arias, Tania Blanco; Martínez, Manuel Muñoz; Crespo, C.; Mazarro, Dolores Ochoa

doi:10.2147/jpr.s326092

Cited by 4 publications

(9 citation statements)

References 25 publications

(35 reference statements)

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“…Some T5 outcome measures exhibited slight improvement compared to baseline values, yet it was roughly equivalent to one SEM, indicating a non-clinically significant change. The long-term decline in SCS effects among the Perm group was unexpected, considering reports on ongoing effect of SCS for long durations, ranging from 3 to 48 months (e.g., Brinzeu et al, 2019;Campos et al, 2019;Eriksen et al, 2021;Hunter et al, 2018;Kumar et al, 2008;Rojo et al, 2021;Sears et al, 2011).…”

Section: Discussionmentioning

confidence: 90%

Short‐ and long‐term effects of conventional spinal cord stimulation on chronic pain and health perceptions: A longitudinal controlled trial

Brill

Defrin

Aryeh

et al. 2022

European Journal of Pain

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Background The effectiveness and long‐term outcomes of spinal cord stimulation (SCS) are not fully established, especially considering that data from patients who withdrew from the trial are rarely analysed, which may lead to overestimation of SCS efficacy. We evaluated short‐ and long‐term effects of SCS on chronic pain and perceived health, beyond natural variability in these outcomes. Methods In a prospective design, 176 chronic pain patients referred to SCS were evaluated five times (baseline; retest ~6 weeks later; post‐SCS trial; 8 and 28 weeks post‐permanent implantation). Patients whose SCS trial failed (Temp group) were followed up and compared to those who underwent permanent SCS (Perm group). Results Analyses revealed a non‐linear (U‐shaped) trend significantly different between the two groups. In the Perm group, a significant improvement occurred post‐SCS implantation in pain severity, pain interference, health‐related quality of life and self‐rated health, which was followed by gradual worsening and return to baseline values at end of follow‐up. In the Temp group, only minor changes occurred in these outcomes over time. On average, baseline and end of follow‐up values in the Perm and Temp groups were similar: ~40% in each group exhibited an increase in pain severity over time and 38% and 33%, respectively, exhibited reductions in pain severity over time. Conclusions Since the greatest improvement in the outcome measures occurred from baseline to post‐SCS trial (T1–T3) followed by a gradual decline in the effect, it appears that SCS may not be effective for the majority of chronic pain patients. Significance This longitudinal study evaluated short and long term effects of spinal cord stimulation (SCS) on chronic pain outcome measures, beyond their natural variation in time. Despite significant short term improvements, by the end of the seven months' follow‐up, the outcomes in the treatment group (people who received the permanent implantation) were similar to those of the control group (people whose SCS trial failed and did not continue to permanent implantation) suggesting SCS may not be cost‐effective for chronic pain patients.

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Section: Discussionmentioning

confidence: 90%

Short‐ and long‐term effects of conventional spinal cord stimulation on chronic pain and health perceptions: A longitudinal controlled trial

Brill

Defrin

Aryeh

et al. 2022

European Journal of Pain

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“…is expressed in terms of cost/QALY and differs based on economic region or country and calculation method 21. In the United States, it is commonly set at less than US$50,000/QALY (ie, highly cost effective) or US$100,000/QALY (ie, cost-effective), in the UK, £20,000–30,000/QALY and in Spain, €30,000/QALY 21–25. WTP in terms of QALY allows for the comparison between cost-effectiveness ratios for a specific treatment determined via a standardized measure of efficacy—the QALY which is derived from patient utility values, generally calculated from EuroQol-5D (EQ-5D) questionnaire data and the direct economic comparison of similar treatment options.…”

Section: Methods and Understanding Economic Evaluationmentioning

confidence: 99%

“…SCS is historically reserved for patients who are not likely candidates for reoperation and have pain intractable to CMM 29 30. Economic evaluations, as presented in table 1, have been conducted to evaluate costs and/or cost-effectiveness of SCS 20 22–26 28–40. Only one study indicated SCS was inferior to other treatment options, specifically in the workers compensation population 37…”

Section: Cost-effectiveness Of Neuromodulationmentioning

confidence: 99%

“…For this population, lumbar spine surgery has been associated with higher postoperative pain and disability scores, lower satisfaction rates, and slower return to work 41. Since the Hollingworth et al 37 study, four further SCS cost-effectiveness studies have been published which all found SCS to be cost-effective, at least in a period greater than 2 years 23 25 26 40…”

Section: Cost-effectiveness Of Neuromodulationmentioning

confidence: 99%

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Daring discourse: economics of neuromodulation for the treatment of persistent spinal pain syndrome and complex regional pain syndrome

Provenzano

Heller

2023

Reg Anesth Pain Med

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The treatment options for patients with chronic pain conditions are impacted by recent research, patient needs, and insurance coverage. Although various factors affect the cost of healthcare, the economic burden on the patient and the healthcare system must be considered when choosing the appropriate treatments for each patient. This Daring Discourse aims to review and further clarify existing economic evaluations and thus examine cost-effectiveness with regards to neuromodulation for the treatment of persistent spinal pain syndrome and complex regional pain syndrome. Specific consideration is given to spinal cord stimulation, as it is a widely studied and implemented neuromodulation modality for the treatment of these debilitating conditions.

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“…The incidence of FBSS is reported to be between 10 and 40% ( 2 ). It is reported to occur in up to 19% of cases after microdiscectomy and 25.5 and 40% of cases after laminectomy ( 3 , 4 ). FBSS has multiple etiologies, including surgery adjacent lesion to the disc or facet area, persistent or recurrent neural compression, neuritis, fibrosis, hardware pain, and psychosocial factors ( 5 – 8 ).…”

Section: Introductionmentioning

confidence: 99%

The analgesic effect of lumbar sympathetic ganglion block in patients with failed back surgery syndrome

Lee

Sim²,

Kim³

et al. 2023

Front. Med.

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BackgroundPersistent or recurrent lumbosacral pain is a common symptom after spinal surgery. Several interventions have been introduced for failed back surgery syndrome; however, their clinical efficacy, safety, and cost-effectiveness are insufficient. Sympathetic ganglion block has been selected for pain associated with the sympathetic nervous system. In this study, we compared pain and quality of life in patients with failed back surgery syndrome who responded and did not respond to lumbar sympathetic ganglion block.MethodsWe included 84 patients diagnosed with failed back surgery syndrome who had lumbosacral pain and underwent lumbar sympathetic ganglion block between January 2020 and April 2021. The patients’ data were retrospectively analyzed; clinical outcomes were assessed before (T0), 1 week after (T1), and 4 weeks after (T4) lumbar sympathetic ganglion block. Based on the pain difference from T0 to T1, we categorized patients into two groups: patients with ≥ 50% pain reduction (responder group) and patients with < 50% pain reduction (non-responder group). Demographic, clinical, surgical, and fluoroscopic data were evaluated and compared. The primary outcome was pain scores and the EuroQol-5D score from T0 to T4.ResultsAmong the 84 patients analyzed, 41 (48.8%) experienced ≥ 50% pain reduction at 1 week after lumbar sympathetic ganglion block. Lumbar sympathetic ganglion block significantly improved pain at T1 and T4 compared to T0 in both groups. Lumbar sympathetic ganglion block improved the EuroQol-5D score at T1 compared to T0 in the responder group. The responder group had a significant decrease in pain at T1 from T0 and T4 from T0 and a significant decrease in the EuroQol-5D score at T1 from T0 compared with the non-responder group. Coldness of the leg over time did not differ between the groups. No serious adverse events occurred in either of the groups.ConclusionLumbar sympathetic ganglion block may improve pain at 1 and 4 weeks in patients with failed back surgery syndrome. Patients with ≥ 50% pain reduction at 1 week showed simultaneous improvement in quality of life and pain reduction at 4 weeks.Clinical trial registrationhttps://cris.nih.go.kr/cris/index/index.do, identifier KCT0007236.

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Real-World Cost-Effectiveness Analysis of Spinal Cord Stimulation vs Conventional Therapy in the Management of Failed Back Surgery Syndrome

Cited by 4 publications

References 25 publications

Short‐ and long‐term effects of conventional spinal cord stimulation on chronic pain and health perceptions: A longitudinal controlled trial

Short‐ and long‐term effects of conventional spinal cord stimulation on chronic pain and health perceptions: A longitudinal controlled trial

Daring discourse: economics of neuromodulation for the treatment of persistent spinal pain syndrome and complex regional pain syndrome

The analgesic effect of lumbar sympathetic ganglion block in patients with failed back surgery syndrome

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