Cost-utility analysis of transcranial direct current stimulation therapy with and without virtual illusion for neuropathic pain for adults with spinal cord injury in Canada

The Journal of Spinal Cord Medicine, 2021 · DOI: 10.1080/10790268.2021.1961051 · Published: January 1, 2021

Spinal Cord Injury Healthcare Pain Management

Simple Explanation

This study evaluates the cost-effectiveness of using virtual illusion (VI) combined with transcranial direct current stimulation (tDCS) for treating neuropathic pain in adults with spinal cord injuries in Canada, compared to using tDCS alone or standard pharmacological care. The analysis considers costs from a societal perspective, including healthcare expenses and productivity losses, over a three-month period. A Markov model simulates a cohort of 1000 individuals, tracking their movement between different pain severity states (no/mild, moderate, severe) to determine the incremental cost-utility ratio (ICER) of the treatments.

Study Duration

3 Months

Participants

Individuals with spinal cord injury and neuropathic pain resistant to pharmacological therapy

Evidence Level

Cost-utility analysis using Markov model methods

Key Findings

1
VI and tDCS therapy costs $3,396 per QALY compared to standard care.
2
tDCS therapy alone costs $33,167 per QALY.
3
VI and tDCS therapy had lower incremental costs (−$519) and higher incremental QALYs (0.026) compared to tDCS alone.

Research Summary

This cost-utility analysis suggests that virtual illusion (VI) combined with transcranial direct current stimulation (tDCS) may be more cost-effective than tDCS alone for treating neuropathic pain (NP) in adults with spinal cord injuries (SCI) over a three-month period. The study, conducted from a societal perspective in Ontario, Canada, used a Markov model to simulate a cohort of individuals with SCI experiencing NP, comparing the costs and quality-adjusted life years (QALYs) gained with VI and tDCS therapy, tDCS alone, and standard pharmacological care. The findings indicate that VI and tDCS combination therapy merits consideration for treating NP in adults with spinal cord injuries, based on conventional health technology funding thresholds.

Practical Implications

Healthcare Policy

The study supports the consideration of VI and tDCS combination therapy for public funding as a treatment option for neuropathic pain following spinal cord injury.

Clinical Practice

Clinicians should consider VI and tDCS therapy as a viable treatment option for patients with spinal cord injury experiencing neuropathic pain resistant to standard pharmacological care.

Future Research

Further clinical trials with larger sample sizes are needed to investigate the long-term effects of VI and tDCS therapy on pain intensity and secondary complications in individuals with neuropathic pain and spinal cord injury.

Study Limitations

1
Small sample sizes in the clinical trials used to derive patient-level data increase uncertainty around the data inputs.
2
Exclusion of adverse event-related costs due to the unavailability of frequency data at each pain severity level.
3
The short time horizon of three months may not capture future costs and benefits associated with VI and tDCS treatment for neuropathic pain.

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