Department of Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, OH, USA.
The Center for Pain Relief, Charleston, WA, USA.
Neuromodulation. 2021 Jun;24(4):708-718. doi: 10.1111/ner.13134. Epub 2020 Mar 9.
ACCURATE, a randomized controlled trial, compared safety and effectiveness of stimulation of the dorsal root ganglion (DRG) vs. conventional spinal cord stimulation (SCS) in complex regional pain syndrome (CRPS-I and II) of the lower extremities. This analysis compares cost-effectiveness of three modalities of treatment for CRPS, namely DRG stimulation, SCS, and comprehensive medical management (CMM).
The retrospective cost-utility analysis combined ACCURATE study data with claims data to compare cost-effectiveness between DRG stimulation, SCS, and CMM. Cost-effectiveness was evaluated using a Markov cohort model with ten-year time horizon from the U.S. payer perspective. Incremental cost-effectiveness ratio (ICER) was reported as cost in 2017 U.S. dollars per gain in quality-adjusted life years (QALYs). Willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY were used to define highly cost-effective and cost-effective therapies.
Both DRG and SCS provided an increase in QALYs (4.96 ± 1.54 and 4.58 ± 1.35 QALYs, respectively) and an increase in costs ($153,992 ± $36,651 and $128,269 ± $27,771, respectively) compared to CMM (3.58 ± 0.91 QALYs, $106,173 ± $27,005) over the ten-year model lifetime. Both DRG stimulation ($34,695 per QALY) and SCS ($22,084 per QALY) were cost-effective compared to CMM. In the base case, ICER for DRG v SCS was $68,095/QALY.
DRG and SCS are cost-effective treatments for chronic pain secondary to CRPS-I and II compared to CMM. DRG accrued higher cost due to higher conversion from trial to permanent implant and shorter battery life, but DRG was the most beneficial therapy due to more patients receiving permanent implants and experiencing higher quality of life compared to SCS. New DRG technology has improved battery life, which we expect to make DRG more cost-effective compared to both CMM and SCS in the future.
ACCURATE 是一项随机对照试验，比较了下肢复杂性区域疼痛综合征（CRPS-I 和 II）患者接受背根神经节（DRG）刺激与传统脊髓刺激（SCS）的安全性和有效性。本分析比较了三种治疗复杂性区域疼痛综合征的方法的成本效益，即 DRG 刺激、SCS 和综合医疗管理（CMM）。
这项回顾性成本效用分析结合了 ACCURATE 研究数据和索赔数据，以比较 DRG 刺激、SCS 和 CMM 之间的成本效益。从美国支付者的角度，使用具有十年时间范围的 Markov 队列模型评估成本效益。增量成本效益比（ICER）以 2017 年美元/质量调整生命年（QALY）报告，增量成本效益比（ICER）表示每增加一个质量调整生命年（QALY）的成本。使用 50000 美元/QALY 和 100000 美元/QALY 的支付意愿阈值来定义高度有效的和有效的治疗方法。
与 CMM（3.58±0.91 QALY，106173±27005 美元）相比，DRG（4.96±1.54 QALY，153992±36651 美元）和 SCS（4.58±1.35 QALY，128269±27771 美元）都增加了 QALYs，并且增加了成本。在整个十年的模型寿命内，DRG 刺激（每 QALY 34695 美元）和 SCS（每 QALY 22084 美元）均比 CMM 更具成本效益。在基础情况下，DRG 与 SCS 的 ICER 为 68095 美元/QALY。
与 CMM 相比，DRG 和 SCS 是治疗 CRPS-I 和 II 继发慢性疼痛的有效治疗方法。由于从试验到永久性植入的转换率较高且电池寿命较短，DRG 产生了较高的成本，但由于与 SCS 相比，更多的患者接受永久性植入且生活质量更高，因此 DRG 是最有益的治疗方法。新的 DRG 技术提高了电池寿命，这使得我们预计在未来，DRG 将比 CMM 和 SCS 更具成本效益。
