Highlights
- •Painful diabetic peripheral neuropathy carries a high (economic) burden.
- •Spinal cord stimulation is not cost-effective at the short term due to substantial initial investment.
- •Extended follow-up and a decision model are needed to estimate long term cost-effectiveness.
Abstract
The objective was to perform an economic evaluation comparing spinal cord stimulation
(SCS) in combination with best medical treatment (BMT) with BMT in painful diabetic
peripheral neuropathy patients. Alongside a prospective 2-center randomized controlled
trial, involving 36 painful diabetic peripheral neuropathy patients with severe lower
limb pain not responding to conventional therapy, an economic evaluation was performed.
Incremental cost-effectiveness ratios were based on: 1) societal costs and quality-adjusted
life years (QALYs), and 2) direct health care costs and the number of successfully
treated patients, respectively, both with a time horizon of 12 months. Bootstrap and
secondary analyses were performed to address uncertainty. Total societal cost amounted
to €26,539.18 versus €5,313.45 per patient in the SCS and BMT group, respectively.
QALYs were .58 versus .36 and the number of successfully treated patients was 55%
versus 7% for the SCS and BMT group, respectively. This resulted in incremental cost-effectiveness
ratios of €94,159.56 per QALY and €34,518.85 per successfully treated patient, respectively.
Bootstrap analyses showed that the probability of SCS being cost-effective ranges
from 0 to 46% with willingness to pay threshold values ranging between €20,000 and
€80,000 for a QALY. Secondary analyses showed that cost-effectiveness of SCS became
more favorable after correcting for baseline cost imbalance between the 2 groups,
extending the depreciation period of SCS material to 4 years, and extrapolation of
the data up to 4 years. Although SCS was considerably more effective compared with
BMT, the substantial initial investment that is required resulted in SCS not being
cost-effective in the short term. Cost-effectiveness results were sensitive to baseline
cost imbalances between the groups and the depreciation period of the SCS material.
Perspective
Painful diabetic peripheral neuropathy is a common complication of diabetes mellitus
and the humanistic and economic burden is high. This article presents the cost-effectiveness
of SCS in patients suffering from painful diabetic peripheral neuropathy from a societal
and health care perspective with a time horizon of 12 months.
Key words
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Article info
Publication history
Published online: December 12, 2016
Accepted:
November 26,
2016
Received in revised form:
November 22,
2016
Received:
March 16,
2016
Footnotes
This study was supported by Medtronic for providing a grant for the employment of 1 researcher for 3 years. Medtronic was not involved in the analysis and interpretation of the data or in writing the report.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Trial registry number at ClinicalTrials.gov: NCT01162993.
Identification
Copyright
© 2016 by the American Pain Society
