Cost-Effectiveness of Differential Target Multiplexed Spinal Cord Stimulation for the Treatment of PSPS Type 1 from the Belgian Perspective.

Abstract

Spinal cord stimulation (SCS) using the Differential Target Multiplexed (DTM) waveform is an effective treatment for treating chronic neuropathic back and leg pain that is refractory to other interventions. The purpose of this research was to estimate the cost-effectiveness of this therapy in a population with Persistent Spinal Pain Syndrome Type 1 (PSPS T1) by updating an existing model with inputs from Belgian healthcare databases and Western European clinical data. A two-phase model was built using a 24-month decision tree followed by a 13-year Markov model. Model inputs were sourced from a recent European randomized controlled trial evaluating DTM-SCS for the treatment of PSPS T1, other published literature, and publicly available Belgian healthcare data. Costs and quality-adjusted life years (QALYs) were calculated using deterministic analysis. One-way sensitivity analyses were conducted to test the effect of individual model input parameters on results. Overall model uncertainty was tested using probabilistic sensitivity analysis. The model estimated that DTM-SCS would be cost-effective versus conventional medical management (CMM) in 99.7% of 10,000 simulations, at an assumed willingness-to-pay threshold of €30,000. DTM-SCS patients gained 1.29 QALYs compared to CMM patients, resulting in an incremental cost-effectiveness ratio (ICER) of €11,518 and an incremental net benefit (INB) that became positive at year 5. The base-case results remained robust in scenario analyses, which found that medication use, utilities associated with suboptimal and optimal pain relief, and the time horizon were the largest drivers of uncertainty in the model. The results of the model suggest that DTM-SCS is likely to be a cost-effective treatment option for PSPS T1 compared to CMM for patients in the Belgian healthcare system. Spinal cord stimulation (SCS) has been used for decades to help people manage chronic low-back pain when other conventional medical management (CMM) treatments do not provide adequate pain relief. In the last five years several clinical studies have evaluated the clinical outcomes of SCS among patients with Persistent Spinal Pain Syndrome (PSPS Type 1), also known as non-surgical refractory back pain (NSRBP) or patients without history of prior major back surgery. In this study, the researchers evaluated whether or not treatment with a novel form of SCS, called Differential Target Multiplexed SCS (DTM-SCS), is cost-effective compared to treatment with CMM alone, in a population of patients with pain classified as PSPS Type 1. Using cost information from the Belgian healthcare system and data about clinical outcomes from a randomized, controlled clinical trial, this study developed an economic model to estimate how much Belgian healthcare payers could expect to pay for the typical patient over 15 years of DTM-SCS treatment vs CMM alone. The results of the model showed that, on average, treatment with DTM-SCS gave patients with PSPS Type 1 more years of better health (called quality-adjusted life years, or QALYs) compared to CMM, even though DTM-SCS treatment costs more upfront. The extra cost was considered reasonable for the QALY benefit by European “willingness-to-pay” standards, and therefore the researchers concluded that DTM-SCS was more likely than not to be a cost-effective treatment for PSPS Type 1 in Belgium.