Abstract | OBJECTIVE: DESIGN: Markov models were developed to evaluate the cost-effectiveness of SCS vs CMM alone from the perspective of a Canadian provincial Ministry of Health. Each model followed costs and outcomes in 6-month cycles. Health effects were expressed as quality-adjusted life years (QALYs). Costs were gathered from public sources and expressed in 2012 Canadian dollars (CAN$). Costs and effects were calculated over a 20-year time horizon and discounted at 3.5% annually, as suggested by the National Institute of Clinical Excellence. Cost-effectiveness was identified by deterministic and probabilistic sensitivity analysis (50,000 Monte-Carlo iterations). Outcome measures were: cost, QALY, incremental net monetary benefit (INMB), incremental cost-effectiveness ratio (ICER), expected value of perfect information (EVPI), and strategy selection frequency. RESULTS: The ICER for SCS was: CAN$ 9,293 (FBSS), CAN$ 11,216 (CRPS), CAN$ 9,319 (PAD), CAN$ 9,984 (RAP) per QALY gained, respectively. SCS provided the optimal economic path. The probability of SCS being cost-effective compared with CMM was 75-95% depending on pathology. SCS generates a positive INMB for treatment of pain syndromes. Sensitivity analyses demonstrated that results were robust to plausible variations in model costs and effectiveness inputs. Per-patient EVPI was low, indicating that gathering additional information for model parameters would not significantly impact results. CONCLUSION: SCS with CMM is cost-effective compared with CMM alone in the management of FBSS, CRPS, PAD, and RAP.
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Authors | Krishna Kumar, Syed Rizvi |
Journal | Pain medicine (Malden, Mass.)
(Pain Med)
Vol. 14
Issue 11
Pg. 1631-49
(Nov 2013)
ISSN: 1526-4637 [Electronic] England |
PMID | 23710759
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Wiley Periodicals, Inc. |
Topics |
- Angina Pectoris
(complications, therapy)
- Canada
- Chronic Pain
(etiology, therapy)
- Complex Regional Pain Syndromes
(therapy)
- Cost-Benefit Analysis
- Failed Back Surgery Syndrome
(therapy)
- Female
- Humans
- Male
- Markov Chains
- Middle Aged
- Peripheral Arterial Disease
(complications)
- Quality-Adjusted Life Years
- Spinal Cord Stimulation
(economics)
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