Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, England, UK; National Cancer Institute of Thailand, Department of Medical Service, Ministry of Public Health, Thailand.
Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, England, UK.
Value Health. 2020 May;23(5):656-665. doi: 10.1016/j.jval.2020.02.005. Epub 2020 Apr 20.
Spinal cord stimulation (SCS) is a recognized treatment for chronic pain. This systematic review aims to assess economic evaluations of SCS for the management of all chronic pain conditions, summarize key findings, and assess the quality of studies to inform healthcare resource allocation decisions and future research.
Economic evaluations were identified by searching general medical and economic databases complemented with screening of reference lists of identified studies. No restrictions on language or treatment comparators were applied. Relevant data were extracted. The quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.
Fourteen studies met the inclusion criteria and were judged to be of acceptable quality. Economic evaluations assessed SCS for the management of refractory angina pectoris, failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), diabetic peripheral neuropathy (DPN), and peripheral arterial disease. Model-based studies typically applied a 2-stage model, i.e. decision tree followed by Markov model. Time horizon varied from 1 year to lifetime. Cost-effectiveness ranged widely from dominant (SCS cost-saving and more effective) to incremental cost-effectiveness ratio of >£100,000 per quality-adjusted life-year. Cost-effectiveness appeared to depend on the time horizon, choice of comparator, and indication. Ten of the studies indicated SCS as cost-saving or cost-effective compared with the alternative strategies.
The results consistently suggest that SCS is cost-effective when considering a long-term time horizon, particularly for the management of FBSS and CRPS. Further studies are needed to assess the cost-effectiveness of SCS for ischemic pain and DPN.
脊髓刺激（SCS）是一种公认的慢性疼痛治疗方法。本系统评价旨在评估 SCS 治疗各种慢性疼痛疾病的经济评估，总结主要发现，并评估研究质量，以为医疗资源配置决策和未来研究提供信息。
通过搜索综合医学和经济数据库，并辅以对已确定研究的参考文献列表进行筛选，确定经济评估。未对语言或治疗对照进行限制。提取相关数据。使用统一健康经济评估报告标准（CHEERS）清单评估纳入研究的质量。
符合纳入标准的有 14 项研究，被认为具有可接受的质量。经济评估评估了 SCS 治疗难治性心绞痛、失败的背部手术综合征（FBSS）、复杂性区域疼痛综合征（CRPS）、糖尿病周围神经病变（DPN）和外周动脉疾病。基于模型的研究通常采用两阶段模型，即决策树 followed 马尔可夫模型。时间范围从 1 年到终生。成本效益比范围广泛，从占主导地位（SCS 成本节约和更有效）到每增加一个质量调整生命年的增量成本效益比超过 10 万英镑。成本效益似乎取决于时间范围、对照选择和适应症。其中 10 项研究表明，与替代策略相比，SCS 具有成本节约或成本效益。
结果一致表明，从长期时间范围考虑，SCS 具有成本效益，特别是对于 FBSS 和 CRPS 的管理。需要进一步研究评估 SCS 对缺血性疼痛和 DPN 的成本效益。
