Treatment for Chronic Low Back Pain After Lumbar Spine Surgery: A Cost-effectiveness Analysis of Adding Spinal Cord Stimulation to Conventional Medical Management in Sweden

Abstract

Introduction: Patients with chronic low back pain after lumbar spine surgery usually suffer severe disability and require higher healthcare resources demand. Spinal cord stimulation (SCS) is suggested as cost-effective. However, less evaluation has been carried out from a common clinical practice perspective and considered different patients’ characteristics. Aim: This study aims to evaluate the cost-effectiveness of adding SCS to conventional medical management (CMM) compared with CMM alone in chronic low back pain patients after lumbar spine surgery from a common clinical practice setting in Sweden. Methods: A two-stage decision analytical model was used to evaluate the costs and health effects of SCS and CMM, comprised of a six-month decision tree and a fifteen-year Markov model, using secondary data from published scientific articles and register databases. Results: In the base case analysis, the incremental cost-effectiveness ratio of adding SCS to CMM compared with CMM alone was estimated to be 498,522 SEK and 173,387 SEK, from the healthcare payer perspective and the limited societal perspective, respectively. The results were considered cost effective at a willingness to pay threshold of 500,000 SEK. Results from probabilistic sensitivity analysis indicated 46% of iterations suggest that adding SCS to CMM was cost-effective from a healthcare payer perspective, whereas from a limited societal perspective analysis, 97% of iterations suggest it is cost-effective. Conclusion: Adding SCS to CMM is cost-effective from a limited societal perspective compared to using CMM alone. Results uncertainty from a healthcare payer perspective was found, and further studies need to be conducted to determine the long-term health effects of SCS.