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. 2024 Jul;27(5):908-915.
doi: 10.1016/j.neurom.2024.02.009.

Differential Target Multiplexed Spinal Cord Stimulation: A UK Cost-Effectiveness Analysis

Ashish Gulve  1 , Vivek Mehta  2 , David A Provenzano  3 , Simon Eggington  4 , Shanti Scheffler  4 , Nicolas C Gasquet  5 , Christine N Ricker  5
Affiliations
Free article

Differential Target Multiplexed Spinal Cord Stimulation: A UK Cost-Effectiveness Analysis

Ashish Gulve et al. Neuromodulation. 2024 Jul.
Free article

Abstract

Objectives: The aim of this economic analysis was to evaluate the cost-effectiveness of differential target multiplexed spinal cord stimulation (DTM-SCS) for treating chronic intractable low back pain, compared with conventional spinal cord stimulation (C-SCS) and conservative medical management (CMM), by updating and expanding the inputs for a previously published cross-industry model.

Materials and methods: This model comprised a 12-month decision-tree phase followed by a long-term Markov model. Costs and outcomes were calculated from a UK National Health Service perspective, over a base-case horizon of 15 years and up to a maximum of 40 years. All model inputs were derived from published literature or other deidentified sources and updated to reflect recent clinical trials and costs. Deterministic and one-way sensitivity analyses were performed to calculate costs and quality-adjusted life-years (QALYs) across the 15-year time horizon and to explore the impact of individual parameter variability on the cost-effectiveness results. Probabilistic sensitivity analysis was undertaken to explore the impact of joint parameter uncertainty on the results.

Results: DTM-SCS was the most cost-effective option from a payer perspective. Compared with CMM alone, DTM-SCS was associated with an incremental cost-effectiveness ratio (ICER) of £6101 per QALY gained (incremental net benefit [INB] = £21,281). The INB for C-SCS compared with CMM was lower than for DTM-SCS, at £8551. For the comparison of DTM-SCS and C-SCS, an ICER of £897 per QALY gained was calculated, with a 99.5% probability of cost-effectiveness at a £20,000 per QALY threshold.

Conclusions: Among patients with low back pain treated over a 15-year follow-up period, DTM-SCS and C-SCS are cost-effective compared with CMM, from both payer and societal perspectives. DTM-SCS is associated with a lower ICER than that of C-SCS. Wider uptake of DTM-SCS in the UK health care system is warranted to manage chronic low back pain.

Keywords: Cost-effectiveness; United Kingdom; differential target multiplexed; low back pain; spinal cord stimulation.

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Conflict of interest statement

Conflict of Interest Ashish Gulve reports a relationship with Medtronic Inc that includes consulting or advisory and speaking and lecture fees. Vivek Mehta reports a relationship with Medtronic Inc that includes consulting or advisory and funding grants; a relationship with Boston Scientific Corp that includes consulting or advisory and funding grants; a relationship with Pfizer Inc that includes consulting or advisory; and a relationship with Mainstay Medical that includes consulting or advisory and funding grants. David A. Provenzano reports a relationship with Avanos Medical Inc that includes consulting or advisory and funding grants; a relationship with Medtronic Inc that includes consulting or advisory and funding grants; a relationship with Nevro Corp that includes consulting or advisory and funding grants; a relationship with SI-BONE Inc that includes consulting or advisory; a relationship with Stimgenics that includes funding grants; and a relationship with Abbott that includes funding grants. Ashish Gulve, Vivek Mehta, and David A. Provenzano did not receive any funding from Medtronic or other sources related to this research; however, they did receive funding from Medtronic for engagements unrelated to the present research submission. Simon Eggington, Shanti Scheffler, Nicolas C. Gasquet, and Christine N. Ricker are or were full-time employees of Medtronic at the time of this research.

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