BACKGROUND: Spinal cord stimulation (SCS) is recommended in NICE clinical guidelines for adults who continue to experience chronic pain of neuropathic origin despite appropriate conventional medical management (CMM). SCS devices are commonly separated into two categories: percutaneous linear-type probes and paddle-type probes. The cylindrical, linear design can be implanted percutaneously in a relatively low-risk and simple day surgery procedure. Unfortunately, the benefit of simple implantation is negated by its decreased capability to manage pain because of its limited spatial range and likelihood of migration compared to a paddle-type probe. Paddle SCS exhibits greater efficacy however a more invasive, higher-risk surgical procedure is required to implant the device. Minimally invasive paddle-type SCS (MI-SCS) harnesses ideas from the fields of bioelectronics and soft robotics and combines the spatial coverage of paddle-SCS with the ease of percutaneous implantation.

OBJECTIVES: To develop an early economic model exploring the cost-effectiveness of MI-SCS vs. paddle SCS and percutaneous SCS from the perspective of the UK NHS.

METHODS: A targeted literature review was conducted to identify suitable model structures and data sources to develop a conceptual model that was validated by clinical experts. An early economic model was developed in Microsoft Excel comprising a 6-month decision tree leading into a longer-term Markov, with a total time horizon of 15 years. The comparators included in the model were paddle SCS, and Low Flow and High Flow percutaneous SCS. Due to a lack of comparative data available for all comparators, a Bucher indirect comparison was conducted to derive clinical efficacy parameters.

RESULTS: MI-SCS dominated all comparators, accruing greater QALYs whilst incurring lower costs. The most sensitive model parameter was the explant rate, followed by the odds ratios for optimal pain relief.

CONCLUSIONS: MI-SCS has the potential to be a highly cost-effective treatment for the treatment of chronic neuropathic pain.