The Cost-effectiveness of Spinal Cord Stimulation in the Treatment of Failed Back Surgery Syndrome

Objectives: Healthcare policy makers and payers require cost-effectiveness evidence to inform their treatment funding decisions. Thus, in 2008, the United Kingdom's National Institute of Health and Clinical Excellence analyzed the cost effectiveness of spinal cord stimulation (SCS) compared with conventional medical management (CMM) and with reoperation and recommended approval of SCS in selected patients with failed back surgery syndrome (FBSS). We present previously unavailable details of the National Institute of Health and Clinical Excellence analysis and an analysis of the impact on SCS cost effectiveness of rechargeable implanted pulse generators (IPGs). Methods: We used a decision analytic model to examine the cost effectiveness of SCS versus CMM and versus reoperation in patients with FBSS. We also modeled the impact of nonrechargeable versus rechargeable IPGs. Results: The incremental cost-effectiveness of SCS compared with CMM was 5624 pound per quality-adjusted life year, with 89% probability that SCS is cost effective at a willingness to pay threshold of 20,000 pound. Compared with reoperation, the incremental cost-effectiveness of SCS was 6392 pound per quality-adjusted life year, with 82% probability of cost-effectiveness at the 20,000 pound threshold. When the longevity of an IPG is 4 years or less, a rechargeable (and initially more expensive) IPG is more cost-effective than a nonrechargeable IPG. Discussion: In selected patients with FBSS, SCS is cost effective both as an adjunct to CMM and as an alternative to reoperation. Despite their initial increased expense, rechargeable IPGs should be considered when IPG longevity is likely to be short.