1. Methodological Quality of SCS Cost-Effectiveness Analyses
Rui Duarte, MSc, PhD
Health Technology Assessment Lead, Liverpool Reviews and Implementation Group, University of Liverpool
Rod Taylor, MSc, PhD
Chair of Population Health Research, University of Glasgow
Professor of Health Services Research & Director of Exeter CTU & NIHR Senior Investigator, University of Exeter Medical School
IMMPACT - Research Design Considerations for Randomized Clinical trials of spinal cord stimulation for pain, November 14-16, 2018, Washington DC

2. Previous SRs of CEAs of SCS

3. Aim
What are the research methods employed, which outcomes are assessed, how are these reported, and what are the results of economic evaluations of SCS?

4. Methods – study identification
Databases: MEDLINE, MEDLINE Epub Ahead of Print & MEDLINE In-Process, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CEA Registry & hand searches of included studies
Added economic specific terms
1. spinal cord stimulat$.ti,ab,kw.
2. dorsal column stimulat$.ti,ab,kw.
3. epidural stimulat$.ti,ab,kw.
4. or/1-3
5. (cost-effectiveness or cost-utility).mp.
6. incremental cost-effectiveness ratio.mp.
7. incremental cost-utility ratio.mp.
8. (QALY or LY or life year$).mp.
9. or/5-8
10. 4 and 9

5. Methods – study selection
Two reviewers (RT & RD) reviewed all titles and abstracts
Inclusion/exclusion criteria
During review added the criteria that studies had to be based on comparative clinical evidence – either RCT or nonRCT

6. Methods – study quality
Quality of included SCS cost-effectiveness studies assessed using the CHEERS checklist
24-questions assess quality of reporting

7. Results – included studies
1st author (year)
Pop
Comparison
Type of analysis
Primary data source
Andrell (2003) RA
SCSc vs CABG
Trial-based
RCT
Annemans (2014)
FBSS
SCSc vs SCS-HF vs reop vs CMM
Model-based
Non-RCT
Dyer (2008)
SCSc vs PMR
Hollingworth (2011)
SCSc vs CMM
Kemler (2002)
CRPS
SCSc vs CMM (PT)
Kemler (2010)
Klomp (2006)
CLI
Kumar (2002)
Kumar (2013)
FBSS/CLI/RA/CRPS
North (2007)
SCSc vs reop
Simpson (2009)
FBSS/CRPS
SCSc vs CMM vs reop
Slangen (2007) DN
Taylor (2005)
Trial-based (indirect)
Taylor (2010)

8. Results – quality assessment

9. Results – methodological quality
1st author (year)
CHEERS score
CHEERS score %
issues
Andrell (2003)
13/21
62%
Rod to complete
Annemans (2014)
19/24
79%
Dyer (2008)
22/22
100%
Hollingworth (2011)
20/21
95%
Kemler (2002)
21/22
Kemler (2010)
19/21
90%
Klomp (2006)
Kumar (2002)
Kumar (2013)
23/24
96%
North (2007)
19/22
86%
Simpson (2009)
24/24
Slangen (2007)
Taylor (2005)
Taylor (2010)

10. Conclusions
Quality of included SCS CEA studies as assessed by CHEERS quality of reporting checklist was generally high
Limitation of this analysis: CHEERS checklist developed as a ‘CONSORT for CEA studies’
assists authors and reviewers to check if those items are described but does not account for the appropriateness of what the authors have done (like the risk of bias tool for RCTs as an example).

11. Conclusions cont. Recommendations for future SCS CEAs
Base model-based analyses effectiveness estimates of (non-biased) RCT evidence
And preferably a systematic review/meta-analysis of the literature rather than ‘cherry picking’ studies
Improved specific reporting on: perspective/comparator/discount rates/time horizon/exploration of population heterogeneity (subgroups)