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Randomized Controlled Trial
Resource Use and Cost of Subcutaneous Nerve Stimulation Versus Optimized Medical Management in Patients With Failed Back Surgery Syndrome: An Analysis of the SubQStim Study.
- Colin Green, Sam S Eldabe, Rod S Taylor, Mehdi Zahra, and Simon Eggington.
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.
- Neuromodulation. 2021 Aug 1; 24 (6): 1033-1041.
ObjectivesTo undertake a detailed healthcare resource use and cost analysis of the SubQStim study, which randomized patients with failed back surgery syndrome (FBSS) with low back pain to receive subcutaneous nerve field stimulation in combination with optimized medical management (treatment) or optimized medical management alone (control).Materials And MethodsPatient-level data from the SubQStim study were used to present descriptive analyses of healthcare resource use and estimated costs for pain medication, healthcare visits, adverse events, and device acquisition/implantation. A United Kingdom National Health Service perspective was adopted, using cost data from national tariffs, drug and device prices, and social care cost studies. Results were calculated as the mean cost per patient over the nine-month follow-up period.ResultsMean cost per patient was £18,403 in the treatment group versus £1613 in the control group. Almost 90% of the cost in the treatment group consisted of device acquisition/implantation. Higher adverse event costs were observed for patients in the treatment group, but lower costs were observed for pain medication and healthcare visits. Over nine months, opioid use decreased in the treatment group and increased in the control group. Enrolment and follow-up were terminated early in the clinical study, leading to substantial between-patient variability in each cost category.ConclusionsSubcutaneous nerve field stimulation has the potential to offset the initial costs of the device by reducing analgesic medication and the number of healthcare visits in FBSS patients, alongside potential gains in health-related quality of life. There remains uncertainty in long-term costs and cost-effectiveness of stimulation and longer-term follow-up analyses are needed.© 2021 International Neuromodulation Society.
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