Economic evaluation of spinal cord stimulation for chronic reflex sympathetic dystrophy

Objective: To evaluate the economic aspects of treatment of chronic reflex sympathetic dystrophy (RSD) with spinal cord stimulation (SCS), using outcomes and costs of care before and after the start of treatment. Methods: Fifty-four patients with chronic RSD were randomized to receive either SCS together with physical therapy (SCS+PT; n = 36) or physical therapy alone (PT; n = 18). Twenty-four SCS+PT patients responded positively to trial stimulation and underwent SCS implantation. During 12 months of follow-up, costs (routine RSD costs, SCS costs, out-of-pocket costs) and effects (pain relief by visual analogue scale, health-related quality of life [HRQL] improvement by EQ-5D) were assessed in both groups. Analyses were carried out up to 1 year and up to the expected time of death. Results: SCS was both more effective and less costly than the standard treatment protocol. As a result of high initial costs of SCS, in the first year, the treatment per patient is $4,000 more than control therapy. However, in the lifetime analysis, SCS per patient is $60,000 cheaper than control therapy. In addition, at 12 months, SCS resulted in pain relief (SCS+PT [-2.7] vs PT [0.4] p < 0.001]) and improved HRQL (SCS+PT [0.22] vs PT [0.03] [p = 0.004]). Conclusions: The authors found SCS to be both more effective and less expensive as compared with the standard treatment protocol for chronic RSD.