TY - JOUR
T1 - Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome
T2 - An observational study in a workers compensation population
AU - Hollingworth, William
AU - Turner, Judith A.
AU - Welton, Nicky J.
AU - Comstock, Bryan A.
AU - Deyo, Richard A.
PY - 2011/11/15
Y1 - 2011/11/15
N2 - Study Design: Prospective cohort study. Objective: We estimated the cost-effectiveness of spinal cord stimulation (SCS) among workers compensation recipients with failed back surgery syndrome (FBSS). Summary of Background Data: Randomized controlled trial (RCT) evidence suggests that SCS is more effective at 6 months than medical management for patients with FBSS. However, procedure costs are high and workers compensation claimants often have worse outcomes than other patients. Methods: We enrolled 158 FBSS patients receiving workers compensation into three treatment groups: trial SCS with or without permanent device implant (n = 51), pain clinic (PC) evaluation with or without treatment (n = 39), and usual care (UC; n = 68). The primary outcome was a composite measure of pain, disability and opioid medication use. As reported previously, 5% of SCS patients, 3% of PC patients and 10% of UC patients achieved the primary outcome at 24 months. Using cost data from administrative databases, we calculated the cost-effectiveness of SCS, adjusting for baseline covariates. Results: Mean medical cost per SCS patient over 24 months was $52,091. This was $17,291 (95% confidence intervals [CI], $4100-30,490) higher than in the PC group and $28,128 ($17,620-38,630) higher than in the UC group. Adjusting for baseline covariates, the mean total medical and productivity loss costs per patient of the SCS group were $20,074 ($3840-35,990) higher than those of the PC group and $29,358 ($16,070-43,790) higher than those of the UC group. SCS was very unlikely (<5% probability) to be the most cost-effective intervention. Conclusion: In this sample of workers compensation recipients, the high procedure cost of SCS was not counterbalanced by lower costs of subsequent care, and SCS was not cost-effective. The benefits and potential cost savings reported in RCTs may not be replicated in workers compensation patients treated in community settings.
AB - Study Design: Prospective cohort study. Objective: We estimated the cost-effectiveness of spinal cord stimulation (SCS) among workers compensation recipients with failed back surgery syndrome (FBSS). Summary of Background Data: Randomized controlled trial (RCT) evidence suggests that SCS is more effective at 6 months than medical management for patients with FBSS. However, procedure costs are high and workers compensation claimants often have worse outcomes than other patients. Methods: We enrolled 158 FBSS patients receiving workers compensation into three treatment groups: trial SCS with or without permanent device implant (n = 51), pain clinic (PC) evaluation with or without treatment (n = 39), and usual care (UC; n = 68). The primary outcome was a composite measure of pain, disability and opioid medication use. As reported previously, 5% of SCS patients, 3% of PC patients and 10% of UC patients achieved the primary outcome at 24 months. Using cost data from administrative databases, we calculated the cost-effectiveness of SCS, adjusting for baseline covariates. Results: Mean medical cost per SCS patient over 24 months was $52,091. This was $17,291 (95% confidence intervals [CI], $4100-30,490) higher than in the PC group and $28,128 ($17,620-38,630) higher than in the UC group. Adjusting for baseline covariates, the mean total medical and productivity loss costs per patient of the SCS group were $20,074 ($3840-35,990) higher than those of the PC group and $29,358 ($16,070-43,790) higher than those of the UC group. SCS was very unlikely (<5% probability) to be the most cost-effective intervention. Conclusion: In this sample of workers compensation recipients, the high procedure cost of SCS was not counterbalanced by lower costs of subsequent care, and SCS was not cost-effective. The benefits and potential cost savings reported in RCTs may not be replicated in workers compensation patients treated in community settings.
KW - cost-benefit analysis
KW - cost-effectiveness
KW - failed back surgery syndrome
KW - spinal cord stimulation
KW - workers compensation .
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UR - http://www.scopus.com/inward/citedby.url?scp=80455174000&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e31822a867c
DO - 10.1097/BRS.0b013e31822a867c
M3 - Article
C2 - 21738098
AN - SCOPUS:80455174000
SN - 0362-2436
VL - 36
SP - 2076
EP - 2083
JO - Spine
JF - Spine
IS - 24
ER -