Letter to the editor: Clinical Use, Quality of Life and Cost-Effectiveness of Spinal Cord Stimulation Used to Treat Patients with Failed Back Surgery Syndrome

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Asian Spine J. 2017;11(4):675-676
Publication date (electronic) : 2017 August 07
doi : https://doi.org/10.4184/asj.2017.11.4.675
1Research Centre on Public Health, University of Milan Bicocca, Monza, Italy.
2Universitá Magna Grecia, Catanzaro, Italy.
3Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy.
4Azienda Socio Sanitaria Territoriale dei Sette Laghi, Varese, Italy.
5Azienda Ospedaliera Salvini, Garbagnate Milanese, Garbagnate, Italy.
Corresponding author: Luciana Scalone. CESP, Research Centre on Public Health, University of Milan Bicocca Via Cadore, 48, Monza I-20900, Italy. Tel: +39-(0)39-2333097, Fax: +39-(0)2-700536422, luciana.scalone@unimib.it
Received 2017 May 10; Accepted 2017 May 20.

Waszak et al. [1] published a literature review regarding the clinical use, quality of life, and cost-effectiveness of spinal cord stimulation (SCS) to treat failed back surgery syndrome (FBSS) patients. As the authors did not specify the aims of their review, we inferred them based on their conclusions, namely cost-effectiveness of SCS remains unclear and evidence regarding the role of SCS in FBSS is controversial. After reading their reported conclusions and methods, we were unable to understand the criteria and reasons for which they did not include the study of Zucco et al. [2], who assessed the effects, cost-effectiveness, and cost-utility of SCS for FBSS patients, which would contribute in achieving more robust conclusions regarding the value of this technique in such patients. In particular, we analyzed the selection criteria specified in the review; however, the reported criteria did not help in clarifying the reasons for excluding the study by Zucco et al., although the article can be found in PubMed using the combined keywords specified. The authors stated that the articles were selected based on the Preferred Reporting Items for Systematic Reviews (PRISMA) statement checklist. However, in this checklist [3], we do not note any criteria regarding article selection that clarify the reasons for excluding the study. Finally, the authors of the review specify that “reports on FBSS and SCS needed to have a rigid protocol, inclusion criteria and follow-up strategy” however they do not explain further their meaning, although Zucco et al. used all the methodological data required in the Consolidated Health Economic Evaluation Reporting Standards [4]. In the paragraph that focused on the cost-effectiveness of SCS, Waszak et al. commented on some studies: a Canadian study in which the Markov model was used and a systematic review and economic model that included three randomized controlled trials (RCTs) on neuropathic pain and eight on ischemic pain. They also criticized most of the trials because the trials involved small sample sizes. To note, the authors did not include the economic evaluations conducted by Taylor et al. [5], which were based on the results of the Prospective Randomised Controlled Multicentre Trial of the Effectiveness of Spinal Cord Stimulation (PROCESS) RCTs conducted in Europe, Canada, Australia, and Israel. Furthermore, the authors mentioned that “RCTs that model routine practice may not fully represent the real effects of a technology” and commented on an observational study that showed that SCS was not cost-effective in a US Workers' Compensation Population. Correctly, they also stated that “research on cost-effectiveness strongly depends on features of a healthcare system;” hence, evidence from different healthcare systems in different countries should be considered. For example, the PRECISE study was conducted in a routine clinical practice setting within the Italian healthcare system and involved 80 patients, i.e., a sample population larger than that of previously con-ducted RCTs regarding the same topic [6,7]. This study results show that in clinical practice, SCS can be a value-for-money option for patients with FBSS and characteristics similar to the participants in the PRECISE study. Regardless of this study results, we wonder whether the review by Warszak et al. is methodologically outstanding. Thus, we believe that the conclusions of this review should be cautiously considered.

Notes

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

References

1. Waszak PM, Modric M, Paturej A, et al. Spinal cord stimulation in failed back surgery syndrome: review of clinical use, quality of life and cost-effectiveness. Asian Spine J 2016;10:1195–1204. 27994797.
2. Zucco F, Ciampichini R, Lavano A, et al. Cost-effectiveness and cost-utility analysis of spinal cord stimulation in patients with failed back surgery syndrome: results from the PRECISE study. Neuromodulation 2015;18:266–276. 25879722.
3. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700. 19622552.
4. Husereau D, Drummond M, Petrou S, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS): explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 2013;16:231–250. 23538175.
5. Taylor RS, Ryan J, O'Donnell R, Eldabe S, Kumar K, North RB. The cost-effectiveness of spinal cord stimulation in the treatment of failed back surgery syndrome. Clin J Pain 2010;26:463–469. 20551721.
6. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain 2007;132:179–188. 17845835.
7. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery 2005;56:98–106.

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