Authors' objectives: This health technology assessment evaluates the effectiveness, safety, cost-effectiveness, and budget impact of publicly funding 10-kHz high-frequency spinal cord stimulation (SCS) for adults with chronic noncancer pain that is refractory to medical management.It also evaluates the experiences, preferences, and values of people living with chronic noncancer pain.

Authors' results and conclusions: Results We included 5 studies (7 publications) in the clinical evidence review. Overall, 10-kHz high-frequency SCS likely provides reductions in pain intensity and functional disability, and improvements in quality of life in people with chronic noncancer pain (GRADE: Moderate). As well, patients may reduce their opioid consumption with 10-kHz high-frequency SCS (GRADE: Low). The two included economic evaluations found that 10-kHz high-frequency SCS was cost-saving compared with conventional SCS, but neither was applicable to the Ontario context. Owing to limited evidence about the effectiveness of 10-kHz high-frequency SCS in people who have first tried and failed SCS at lower frequencies (up to 1.2 kHz), we did not conduct a cost-effectiveness analysis comparing this pathway of care and 10-kHz high-frequency SCS for Ontario. Publicly funding 10-kHz high-frequency SCS (using the Freedom SCS system) in Ontario over the next 5 years would lead to a total net cost savings of $0.73 million (ranging from about $0.10 million in year 1 to about $0.21 million in year 5). However, if the province outsourced this therapy using the Senza HF10 SCS system, the total 5-year budget impact would be about $8.76 million. The people we spoke with who had chronic noncancer pain reported that their pain had a substantial negative impact on their activities and emotional well-being. Their direct knowledge of different pain therapies allowed them to provide context and comparisons when they discussed the impact of SCS on their chronic pain. Conclusions For adults with chronic noncancer pain that was refractory to medical management, 10-kHz high-frequency SCS was effective in relieving pain, reducing disability, and improving quality of life. Because there was limited evidence about the effectiveness of 10-kHz high-frequency SCS in people who had first tried and failed SCS at lower frequencies (up to 1.2 kHz), we were unable to determine whether 10-kHz high-frequency SCS is cost-effective in the Ontario context. We estimate that publicly funding 10-kHz high-frequency SCS in Ontario would result in cost savings of about $0.10 million to $0.21 million per year, for a potential total 5-year net cost savings of about $0.73 million. Although people with chronic noncancer pain knew little about SCS before they received it, they reported that it reduced their level of chronic pain, leading to improvements in function and their ability to perform activities of daily living.

Authors' recommendations: The Quality business unit at Ontario Health, based on guidance from the Ontario Health Technology Advisory Committee, recommends publicly funding spinal cord stimulation at frequencies up to and including 10 kHz in adults with chronic noncancer pain that is refractory to medical management

Authors' methods: We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane Risk of Bias and ROBINS-I tools and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search. We analyzed the 5-year budget impact of publicly funding 10-kHz high-frequency SCS in Ontario for adults with chronic noncancer pain who had already tried other available SCS therapies (up to 1.2 kHz). To contextualize the potential value of 10-kHz high-frequency SCS, we spoke with people who had chronic noncancer pain.

Project Status: Completed

URL for project: https://www.hqontario.ca/evidence-to-improve-care/health-technology-assessment/reviews-and-recommendations/10-khz-high-frequency-spinal-cord-stimulation-for-adults-with-chronic-noncancer-pain

Year Published: 2020

URL for published report: https://www.hqontario.ca/evidence-to-improve-care/health-technology-assessment/reviews-and-recommendations/10-khz-high-frequency-spinal-cord-stimulation-for-adults-with-chronic-noncancer-pain

Requestor: Ontario Health Technology Advisory Committee (OHTAC); Ontario Ministry of Health

URL for additional information: https://www.hqontario.ca/evidence-to-improve-care/health-technology-assessment/reviews-and-recommendations/10-khz-high-frequency-spinal-cord-stimulation-for-adults-with-chronic-noncancer-pain

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Ontario

Pubmed ID: 32194881

Organisation Name: Ontario Health

Contact Address: 525 University Ave, Toronto, ON M5G 2L3

Contact Name: Nancy Sikich, Director Health Technology Assessment

Contact Email: oh-hqo_hta@ontariohealth.ca

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