Cost-Effectiveness of Interventional Techniques
The field of neurostimulation has matured over the past decade to emerge as an important modality for the treatment of intractable chronic pain. Despite relatively high initial costs, a breadth of evidence exists, and extensive clinical experience suggest
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Krishna Kumar, Syed Rizvi, Sharon Bishop, and Mariam Abbas
Key Points
• Intrathecal drug therapy (IT) and spinal cord stimulation (SCS) therapy are robust, cost-effective therapies for management of chronic pain and are superior to conventional medical management (CMM). • From a cost-effectiveness standpoint, it is better to have failed SCS and IT than to be maintained on CMM alone. • An integrated approach to the treatment of chronic pain will result in improved utilization of limited health-care resources. • Technological advances that increase hardware lifespan and improve catheter and electrode design will reduce complication rates, further bolstering the already favorable cost profile of these interventions.
Introduction The field of neurostimulation has matured over the past decade to emerge as an important modality for the treatment of intractable chronic pain. Despite relatively high initial costs, a breadth of evidence exists, and extensive clinical experience suggests that spinal cord stimulation and intrathecal drug delivery systems are safe, effective, and economical. The benefits of neuromodulation are manifested in improved functional capability, health-related quality of life (HRQoL), and reduced demand for health-care resources. This results in long-term economic benefit and cost saving. Neuromodulation is a viable option for the early treatment of patients with intractable pain syndromes. This chapter profiles the development, clinical utility, and cost-effectiveness of two popular neuromodulatory modalities: intrathecal drug therapy (IT) for the management of intractable chronic nonmalignant pain (CNMP) and the role of spinal cord stimulation (SCS) in the treatment of failed back surgery syndrome (FBSS).
Spinal Cord Stimulation K. Kumar, M.B.B.S., M.S., FRCSC (*) Department of Neurosurgery, Regina General Hospital, University of Saskatchewan, Medical Office Wing, 1440-14th Ave, Regina, SK, S4P 0W5, Canada e-mail: [email protected] S. Rizvi, M.D. Department of Neurosurgery, Regina General Hospital, c/o Dr. Kumar, 1440-14th Ave, Regina, SK, S4P 0W5, Canada e-mail: [email protected] S. Bishop, BScN, MHlthSci Department of Neurosurgery, Unit 5A, Regina General Hospital, 1440-14th Ave, Regina, SK, S4P 0W5, Canada e-mail: [email protected] M. Abbas Department of Neurosurgery, Regina General Hospital, 1440-14th Ave, Regina, SK, S4P 0W5, Canada e-mail: [email protected]
Background SCS is a safe, reversible, cost-effective, and minimally invasive intervention capable of generating superior outcomes for the treatment of neuropathic pain [1–17]. A large body of evidence supports the application of SCS in a diverse array of clinical scenarios [18–21]. The role of SCS is well established in the treatment for pain resulting from FBSS, complex regional pain syndrome, diabetic neuropathy, and peripheral vascular disease. The beneficial effects of SCS on pain, function, and depression are widely acknowledged [3–5, 22, 23]. It is now recommended that SCS be considered earlier in the trea
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