Objectives: 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).
Materials And Methods: 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.
Results: 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.
Conclusions: 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.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1111/ner.13134 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Prevalence and determinants of metabolic syndrome in 2338 childhood cancer survivors: A Dutch Childhood Cancer Survivor LATER 2 study.
Cancer
January 2025
Department of Internal Medicine, Endocrinology Section, Erasmus Medical Center, Rotterdam, The Netherlands.
Background: Because the occurrence of metabolic syndrome (MetS) might contribute to childhood cancer survivor's excess risk of cardiovascular disease, the authors assessed the prevalence and determinants of MetS in the Dutch Childhood Cancer Survivor Study (DCCSS-LATER2) cohort.
Methods: In total, 2338 adult childhood cancer survivors (CCS) were cross-sectionally assessed for the prevalence of MetS, using the Lifelines cohort (N = 132,226 adults without a history of cancer) as references. The prevalence of MetS was clinically assessed using existing classifications, as well as an alternative method using dual-energy x-ray absorptiometry fat% instead of waist circumference to define abdominal adiposity.
Spinal Cord Stimulation for Low Back Pain: A Systematic Review.
Curr Pain Headache Rep
January 2025
Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA.
Purpose Of Review: Chronic low back pain (LBP) is a prevalent and debilitating condition affecting millions worldwide. Among emerging interventions, spinal cord stimulation (SCS) has gained attention as a potential alternative for managing chronic LBP, particularly when alternative approaches fail to provide adequate relief.
Recent Findings: This systematic review focuses on both residual pain levels and ability to perform daily tasks after treatment with SCS.
Divergent paths: gene evolution in Cryptococcus and implications for pathogenicity.
Curr Med Mycol
April 2024
Department of Biotechnology, College of Science, University of Anbar, Ramadi, Anbar, Iraq.
Background And Purpose: and are highly virulent species that cause diseases, such as meningoencephalitis and pulmonary infections. The gene predominantly determines the virulence of the pathogenic species. This study aimed to examine in both pathogenic and non-pathogenic species.
View Article and Find Full Text PDFMethane mitigation potentials and related costs of China's coal mines.
Fundam Res
November 2024
Department of Geographical Sciences, University of Maryland, College Park, MD 20742, USA.
Mitigating methane (CH) emissions from China's coal mines as the largest contributor to anthropogenic CH emissions is vital for limiting global warming. However, the knowledge about CH mitigation potentials and economic costs of Chinese coal mines remain poorly understood, which hinders the formulation of tailored CH mitigation strategies. Here, we estimate and project China's provincial coal mine methane (CMM) emissions, mitigation potentials and costs under various coal production scenarios, by integrating the dynamic emission factors of CMM and key abatement technologies.
View Article and Find Full Text PDFAssociation of community characteristics as measured by social deprivation index score with prenatal care and obstetrical outcomes.
Am J Perinatol
December 2024
Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, United States.
Objective We aimed to determine the relationships between socioeconomic disadvantage, as measured by the Social Deprivation Index (SDI), and prenatal care (PNC) utilization, obstetrical outcomes, and neonatal complications. Study Design All spontaneously-conceived singleton deliveries of nulliparous gravidae with residence zip code available (n= 4,786) were identified in a population-based database. Deliveries were assigned SDI scores based on preconception zip code.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!