Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: An observational study in a workers compensation population

William Hollingworth, Judith A. Turner, Nicky J. Welton, Bryan A. Comstock, Richard A. Deyo

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2076-2083
Number of pages8
JournalSpine
Volume36
Issue number24
DOIs
StatePublished - Nov 15 2011

Keywords

  • cost-benefit analysis
  • cost-effectiveness
  • failed back surgery syndrome
  • spinal cord stimulation
  • workers compensation .

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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