Authors' objectives: Research question: Is occipital nerve stimulation clinically and cost effective in patients with medically refractory chronic cluster headaches?

Authors' results and conclusions: Six case series reported an overall reduction in cluster headache attack frequency, and four studies showed that between 52.9% and 90% of participants had a greater than 50% reduction in attack frequency. However, these studies are limited by the number of participants (between 8 and 51), the lack of a comparator, and the outcomes and methods of analyses varied across the studies. No studies evaluating the cost-effectiveness of occipital nerve stimulation were identified. Two studies estimated costs or cost savings associated with the use of occipital nerve stimulation, but these were non-comparative. HTW did an analysis to estimate the cost-utility of occipital nerve stimulation as compared to standard care. The results were heavily influenced by assumptions around quality of life and triptan use over time. If it was assumed that clinical effectiveness and triptan use was maintained over time (up to 5 years), occipital nerve stimulation was found to be equally effective or more effective while also cost saving in all scenarios. If it assumed that quality of life returns to baseline at three years after implantation, occipital nerve stimulation is found to be more effective than standard care but not cost-effective (ICER £100,142 per QALY gained). However, if it is assumed that quality of life benefit is maintained over time, occipital nerve stimulation is found to be more effective than standard care and cost effective (ICER £7,556 per QALY gained).

Authors' recommendations: Occipital nerve stimulation shows promise for treating medically refractory chronic cluster headache, but the evidence is insufficient to support routine adoption. There is uncertainty about the therapeutic impact of occipital nerve stimulation from the non-comparative evidence available and the economic consequences are difficult to estimate.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: Further research is recommended to determine the impact of occipital nerve stimulation on the frequency and severity of cluster headache attacks, quality of life and cost implications.

Project Status: Completed

Year Published: 2019

URL for published report: https://www.healthtechnology.wales/reports-guidance/occipital-nerve-stimulation/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk

Copyright: Health Technology Wales