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Slangen R, Faber CG, Schaper NC, et al. A Trial-Based Economic Evaluation Comparing Spinal Cord Stimulation With Best Medical Treatment in Painful Diabetic Peripheral Neuropathy. J Pain. 2017 Apr;18(4):405-414. doi: 10.1016/j.jpain.2016.11.014. Epub 2016 Dec 11.
Discipline Area Score
Physician 4 / 7
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.

Comments from MORE raters

Physician rater

Although interesting, it is difficult to translate cost effectiveness to the US where the healthcare system and costs are so different from The Netherlands. If not cost effective there, it's likely even less so in the US.

Physician rater

The previous paper from this study that came out in 2014 was much more relevant.

Physician rater

Small numbers and short term but if the beneficial effects are reproducible and persistent, then over-time average costs should shrink. Even if it is costlier than BMT, given the poor results of BMT especially in refractory cases, this may well be worth the extra cost. Needs longer-term follow-up and additional patients, but the initial results look very promising, even if more expensive. When this is extended with more patients and if the results hold up, will new insurance cover it???
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