Economic Evaluation

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Economic Evaluation Chapter Summary

Chan B, Benton B, McIntyre A, Mittmann N, Teasell RW, Wolfe DL (2019). Economic evaluation of spinal cord injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan VK, Loh E, McIntyre A, editors. Spinal Cord Injury Rehabilitation Evidence. Version 7.0: p 1-34.

1.0 Chapter Summary

What are economic analyses and are why are they important?

Economic analyses provide valuable information on the burden of illness or economic impact of specific health care interventions. Cost-of-illness studies estimate the total cost burden of a condition to the health care system.  On the other hand, economic evaluations compare the cost and consequences of alternative health care interventions options.  Depending on the unit of measure for health outcomes, the economic evaluation may be a cost effectiveness analysis (non-monetary health outcome), cost utility analysis (outcome in quality adjusted life years) or cost benefit analysis (health outcomes in monetary units).  These analyses help inform health care decision-makers on the value for money of new interventions.

Are there any economic analysis studies for the SCI population?

There was a total of 31 studies that were published in peer-reviewed scientific journals between the 2004 and 2018; 19 economic evaluations and 12 cost of illness studies.

The results from several studies suggest that the following interventions may be cost effective for individuals with SCI: Hydrophilic catheters for intermittent catheterization compared to uncoated catheters

The following interventions were also observed to be cost effective based on a single study:

  • Intrathecal baclofen for disabling spasticity compared to current treatment
  • Trans-anal irrigation compared to conservative bowel management
  • Sacral anterior root stimulation for neurogenic bladder
  • Duplex ultrasound for deep venous thrombosis surveillance
  • Sildenafil for erectile dysfunction
  • Electrical stimulation for pressure injury
  • Telephone support in addition to standard pressure injury management
  • Negative pressure wound therapy with weekly dressings compared to standard care for pressure injury
  • Fibrin sealant for surgical treatment of pressure injury compared to standard surgical debridement
  • Cough stimulator neuroprosthesis for restoration of effective cough compared to standard respiratory management
  • Early decompression for individuals with traumatic cervical SCI

The economic health care burden of SCI appears to be substantial.  However, there is a large range of estimated costs reported in the published literature ranging from $280 for SCI individual out-of-pocket costs for lost income and vehicle repair and replacement in Nigeria to $3.2 million lifetime for an individual injured at 25 years old with a C1-C4 AIS A, B or C injury in the United States.  The total economic burden differs based on injury severity, jurisdiction, timeframe of the observation period and cost components included in the study.

Gaps in the Evidence

  • There are numerous treatment areas and interventions where the economics has not been explored.
  • Economic evidence on new technologies in development for individuals with SCI is absent.
  • There is a lack of understanding on the economic impact of functional impairment.