A Systematic Review of Economic Evaluations Reporting the Cost-Effectiveness of Spinal Cord Stimulation

Siwaporn Niyomsri, Rui V. Duarte, Sam Eldabe, Gregory Fiore, Brian H. Kopell, Ewan McNicol, Rod S. Taylor

Research output: Contribution to journalReview articlepeer-review

29 Scopus citations


Objectives: Spinal cord stimulation (SCS) is a recognized treatment for chronic pain. This systematic review aims to assess economic evaluations of SCS for the management of all chronic pain conditions, summarize key findings, and assess the quality of studies to inform healthcare resource allocation decisions and future research. Methods: Economic evaluations were identified by searching general medical and economic databases complemented with screening of reference lists of identified studies. No restrictions on language or treatment comparators were applied. Relevant data were extracted. The quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: Fourteen studies met the inclusion criteria and were judged to be of acceptable quality. Economic evaluations assessed SCS for the management of refractory angina pectoris, failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), diabetic peripheral neuropathy (DPN), and peripheral arterial disease. Model-based studies typically applied a 2-stage model, i.e. decision tree followed by Markov model. Time horizon varied from 1 year to lifetime. Cost-effectiveness ranged widely from dominant (SCS cost-saving and more effective) to incremental cost-effectiveness ratio of >£100,000 per quality-adjusted life-year. Cost-effectiveness appeared to depend on the time horizon, choice of comparator, and indication. Ten of the studies indicated SCS as cost-saving or cost-effective compared with the alternative strategies. Conclusion: The results consistently suggest that SCS is cost-effective when considering a long-term time horizon, particularly for the management of FBSS and CRPS. Further studies are needed to assess the cost-effectiveness of SCS for ischemic pain and DPN.

Original languageEnglish
Pages (from-to)656-665
Number of pages10
JournalValue in Health
Issue number5
StatePublished - May 2020


  • chronic pain
  • full economic evaluations
  • spinal cord stimulation
  • systematic review


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