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Costs of Neurostimulation

Costs of Neurostimulation. Can We Afford The Therapy in 2020?. Krishna Kumar MBBS MS FRCS(C) Member Ord. of Canada, Saskatchewan Ord. of Merit Clinical Professor of Neurosurgery Department of Neurosurgery Regina Canada. Syed Rizvi MD Department of Neurology University of Saskatchewan

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Costs of Neurostimulation

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  1. Costs of Neurostimulation Can We Afford The Therapy in 2020? Krishna Kumar MBBS MS FRCS(C) Member Ord. of Canada, Saskatchewan Ord. of Merit Clinical Professor of Neurosurgery Department of Neurosurgery • Regina Canada Syed Rizvi MD Department of Neurology University of Saskatchewan Regina Canada

  2. Disclosures Disclosures • Act as a consultant for Medtronic Inc. And Boston Scientific. • Have received research grants from Medtronic Inc.

  3. Disclosures Introduction • Policymakers require evidence of comparative cost-effectiveness in order to continue to make funding decisions • To make the case for neurostimulation we use SCS as a prototype • This presentation illustrates the long-term cost-effectiveness of SCS compared with CMM as projected for the year 2020

  4. Projected National Institute of Arthritis and Musculoskeletal Skin Diseases website. News and Events Page. ghttp://www.niams.nih.gov/ne/highlights/spotlight/2006/back_pain_study.htm. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. 2011. Darrell J. Gaskin, Patrick Richard. The Economic Costs of Pain in the United States. The Journal of Pain, 2012; 13 (8): 715 DOI: 10.1016/j.jpain.2012.03.009

  5. Disclosures Introduction • To evaluate the cost impact of SCS against CMM over time we will project costs for 4 commonly encountered chronic pain syndromes: • FBSS (Failed Back Surgery Syndrome) • CRPS (Complex Regional Pain Syndrome) • PAD (Peripheral Arterial Disease) • RAP (Refractory Angina Pectoris)

  6. Methods Methods • Markov model developed to evaluate the cost-effectiveness of SCS versus CMM • Model inputs derived from 313 patients • Costs and outcomes followed in six-month cycles • Health effects expressed as quality-adjusted life years (QALYs) gained • Costs and effects were evaluated over an 8-year time horizon (2012-2020) and discounted at 3.5% per annum

  7. Methods • Cost-effectiveness was identified by deterministic and probabilistic sensitivity analysis (50,000 Monte-Carlo iterations) • Outcome measures presented: • Cost • Effectiveness (EQ-5D) • Incremental cost-effectiveness ratio (ICER) • Incremental net monetary benefit (INMB) • Acceptability of treatment (CEAC) • Expected value of perfect information (EVPI) • Strategy selection frequency

  8. Judging Cost-effectiveness:Willingness-to-Pay (WTP) • Willingness to Pay: Judging Cost-effectiveness • USA and Canada: $50,000 / QALY 1 , 2 • United Kingdom: £20,000- £30,000 / QALY 3 • 1Braithwaite RS, Meltzer DO, King JT Jr, Leslie D, Roberts MS. Med Care 2008; 46(4): 343-5. • 2King JT Jr, Tsevat J, Lave JR, Roberts MS. Med Decis Making 2005; 25(6): 667–677. • 3Devlin N, Parkin D. Health Economics 2004; 13(5): 437-452.

  9. Markov Model Optimal Health State Implant Success Death SCS Trial SuboptimalHealth State Failure Treatment Options CMM CMM Optimal Health State CMM Death Suboptimal Health State TreeAge Pro 2011 (TreeAge Software Inc., Williamstown MA)

  10. Results

  11. Deterministic Sensitivity Analysis: Tornado Diagram for FBSS • Similar diagram for other pain pathologies Incremental Cost-Effectiveness Ratio

  12. Probabilistic Sensitivity Analysis: ICER Scatter plot for FBSS

  13. Incremental Net Monetary Benefit of SCS over CMM

  14. Cost-Effectiveness Acceptability Curve: SCS over CMM

  15. Strategy Selection Frequency Based on a simulation of 50,000

  16. Reliability of the Model: Expected Value of Perfect Information (EVPI)

  17. Comparative Study of Rechargeable and Non-rechargeable IPG

  18. Conclusion • Based on our projections SCS will remain a cost-effective therapy in the management of neuropathic and ischemic pain in the year 2020 • SCS provided a positive INMB over CMM at WTP thresholds ≥ $7,000 per QALY • The probability of SCS providing a cost-effective alternative to CMM ranged from 74-95%, depending on pathology and WTP • The rechargeable IPG is more cost-effective if the lifespan of a non-rechargeable IPG ≤ 4.25 years

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