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A Trial-Based Economic Evaluation Comparing Spinal Cord Stimulation With Best Medical Treatment in Painful Diabetic Peripheral Neuropathy.
- Source :
-
The journal of pain [J Pain] 2017 Apr; Vol. 18 (4), pp. 405-414. Date of Electronic Publication: 2016 Dec 11. - Publication Year :
- 2017
-
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.<br />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.<br /> (Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Cohort Studies
Diabetic Neuropathies psychology
Female
Humans
Male
Middle Aged
Outcome Assessment, Health Care
Quality of Life
Quality-Adjusted Life Years
Severity of Illness Index
Time Factors
Costs and Cost Analysis
Diabetic Neuropathies economics
Diabetic Neuropathies therapy
Spinal Cord Stimulation economics
Spinal Cord Stimulation methods
Subjects
Details
- Language :
- English
- ISSN :
- 1528-8447
- Volume :
- 18
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The journal of pain
- Publication Type :
- Academic Journal
- Accession number :
- 27965045
- Full Text :
- https://doi.org/10.1016/j.jpain.2016.11.014