OBJECTIVES: Differential Target Multiplexed^TM (DTM) Spinal Cord Stimulation (SCS) has been shown to be more effective than conventional SCS (C-SCS) in reducing pain in patients with chronic lower back pain (LBP). This study assessed the cost-effectiveness of DTM-SCS compared to C-SCS and to conventional medical management (CMM), from the Swedish payor and societal perspectives.

METHODS: A one-year decision tree phase was followed by a long-term Markov phase, with health states partitioning patients according to level of pain relief and continuation of therapy. Data from randomized controlled trials were used to determine health outcomes at one year, with long-term outcomes modelled to incorporate treatment discontinuation and associated worsening of symptoms. Utility weights were applied to each health state to reflect changes in quality of life according to efficacy, and mortality was applied using Swedish life tables. Cost data included: device acquisition and implantation, device replacements, adverse event management, drug- and non-drug pain therapy, treatment withdrawal, and societal costs due to work absenteeism. One-way and probabilistic sensitivity analyses were undertaken to explore decision uncertainty. Costs and effects were discounted at 3% per year, and separate analyses were performed using payer and societal perspectives.

RESULTS: Over 15 years, the pairwise ICERs were 25,166 kr (C-SCS vs. CMM), 15,932 kr (DTM-SCS vs. CMM) and 4,035 kr (DTM-SCS vs. C-SCS). One-way sensitivity analyses demonstrated the robustness of the results, and at a threshold of 500,000 kr per QALY, DTM-SCS was predicted to be the most cost-effective intervention (99.6%). Similar results were obtained when taking a societal perspective, with both SCS forms dominating CMM.

CONCLUSIONS: These results strongly suggest that DTM-SCS is cost-effective from both payer and societal perspectives, and support its wider uptake in the Swedish health care system to manage chronic low back pain in patients with chronic LBP.