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The Journal of Headache and Pain
Published in: The Journal of Headache and Pain 1/2015

Open Access 01-12-2015 | Research article

Cost-effectiveness of stimulation of the sphenopalatine ganglion (SPG) for the treatment of chronic cluster headache: a model-based analysis based on the Pathway CH-1 study

Authors: Jan B. Pietzsch, Abigail Garner, Charly Gaul, Arne May

Published in: The Journal of Headache and Pain | Issue 1/2015

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Abstract

Background

In the recent Pathway CH-1 study, on-demand stimulation of the sphenopalatine ganglion (SPG) by means of an implantable neurostimulation system was proven to be a safe and effective therapy for the treatment of chronic cluster headache. Our objective was to assess the cost-effectiveness of SPG stimulation in the German healthcare system when compared to medical management.

Methods

Clinical data from the Pathway CH-1 study were used as input for a model-based projection of the cost-effectiveness of SPG stimulation through 5 years. Medical management as the comparator treatment was modeled on the basis of clinical events observed during the baseline period of CH-1. The costs of treatment were derived from a previously published cluster headache costing study and 2014 medication, neurostimulator, and procedure costs. We computed the 5-year incremental cost-effectiveness ratio (ICER) in euros per quality-adjusted life year (QALY), with costs and effects discounted at 3 % per year.

Results

SPG stimulation was projected to add 0.325 QALYs over the study period, while adding €889 in cost, resulting in a 5-year ICER of €2,736 per QALY gained. Longer follow-up periods, higher baseline attack frequency, and higher utilization of attack-aborting medications led to overall cost savings. SPG stimulation was found either cost-effective or cost-saving across all scenarios investigated in sensitivity analyses.

Conclusions

Our model-based analysis suggests that SPG stimulation for the treatment of chronic cluster headache, under the assumption of sustained therapy effectiveness, leads to meaningful gains in health-related quality of life and is a cost-effective treatment strategy in the German healthcare system.
Literature
1.
Headache Classification Committee of the International Headache S (2013) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 33(9):629–808, doi:10.1177/0333102413485658CrossRef
2.
Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders: 2nd edition. Cephalalgia 24(1):9–160
3.
Goadsby PJ (2002) Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol 1(4):251–257CrossRefPubMed
4.
Freitag FG, Schloemer F (2014) Medical management of adult headache. Otolaryngol Clin North Am 47(2):221–237, doi:10.1016/j.otc.2013.11.002CrossRefPubMed
5.
May A, Leone M, Afra J, Linde M, Sandor PS, Evers S, Goadsby PJ (2006) EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. Eur J Neurol 13(10):1066–1077, doi:10.1111/j.1468-1331.2006.01566.xCrossRefPubMed
6.
May A (2005) Cluster headache: pathogenesis, diagnosis, and management. Lancet 366(9488):843–855, doi:10.1016/S0140-6736(05)67217-0CrossRefPubMed
7.
Gaul C, Finken J, Biermann J, Mostardt S, Diener HC, Muller O, Wasem J, Neumann A (2011) Treatment costs and indirect costs of cluster headache: a health economics analysis. Cephalalgia 31(16):1664–1672, doi:10.1177/0333102411425866CrossRefPubMed
8.
Schoenen J, Jensen RH, Lanteri-Minet M, Lainez MJ, Gaul C, Goodman AM, Caparso A, May A (2013) Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia 33(10):816–830, doi:10.1177/0333102412473667CrossRefPubMedCentralPubMed
9.
Láinez JJ, May A, Gaul C, Goodman A, Caparso A, Schoenen J (2014) Efficacy of SPG stimulation in relieving acute cluster pain: results from >5000 attacks treated during long-term follow-up of the pathway CH-1 study. Paper presented at the accepted for presentation at 4th European Headache and Migraine Trust International Congress (EHMTIC), Copenhagen, Denmark, 18–21September 2014
10.
Láinez JJ, Schoenen J, Gaul C, Lantéri-Minet M, Goodman A, Caparso A, May A (2014) Sphenopalatine Ganglion Stimulation (SPGS) for Chronic Cluster Headache (CH) treatment – change in Preventive Medication (PM) use at 1 year in the pathway CH-1 study. Paper presented at the presentation at AHS 2014 - American Headache Society 56th Annual Scientific Meeting, Los Angeles, CA, USA, 26–29 June 2014
11.
Cohen DJ, Reynolds MR (2008) Interpreting the results of cost-effectiveness studies. J Am Coll Cardiol 52(25):2119–2126, doi:10.1016/j.jacc.2008.09.018CrossRefPubMedCentralPubMed
12.
Gold M, Siegel J, Russell L, Weinstein M (1996) Cost-effectiveness in health and medicine. Oxford University Press, New York
13.
Weinstein MC, O'Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C, Luce BR, Studies ITFoGRP–M (2003) Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR task force on good research practices–modeling studies. Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes Research 6(1):9–17CrossRef
14.
Rote Liste (2014) Rote Liste Service GmbH 1. ISBN: 978-3-939192-80-0
15.
Ara R, Brazier J (2008) Deriving an algorithm to convert the eight mean SF-36 dimension scores into a mean EQ-5D preference-based score from published studies (where patient level data are not available). Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes Research 11(7):1131–1143, doi:10.1111/j.1524-4733.2008.00352.xCrossRef
16.
Barra S, Lanero S, Madrid A, Materazzi C, Vitagliano G, Ames PR, Gaeta G (2010) Sumatriptan therapy for headache and acute myocardial infarction. Expert Opin Pharmacother 11(16):2727–2737, doi:10.1517/14656566.2010.522567CrossRefPubMed
17.
Stillman MJ, Tepper DE, Tepper SJ, Cho L (2013) QT prolongation, Torsade de Pointes, myocardial ischemia from coronary vasospasm, and headache medications. Part 2: review of headache medications, drug-drug interactions, QTc prolongation, and other arrhythmias. Headache 53(1):217–224, doi:10.1111/j.1526-4610.2012.02299.xCrossRefPubMed
18.
Vanmolkot FH, de Hoon JN (2006) Acute effects of sumatriptan on aortic blood pressure, stiffness, and pressure waveform. Clin Pharmacol Ther 80(1):85–94, doi:10.1016/j.clpt.2006.03.011CrossRefPubMed
19.
Gardner DM, Lynd LD (1998) Sumatriptan contraindications and the serotonin syndrome. Ann Pharmacother 32(1):33–38CrossRefPubMed
20.
Nezvalova-Henriksen K, Spigset O, Nordeng H (2013) Triptan safety during pregnancy: a Norwegian population registry study. Eur J Epidemiol 28(9):759–769, doi:10.1007/s10654-013-9831-xCrossRefPubMed
21.
Jurgens TP, Gaul C, Lindwurm A, Dresler T, Paelecke-Habermann Y, Schmidt-Wilcke T, Lurding R, Henkel K, Leinisch E (2011) Impairment in episodic and chronic cluster headache. Cephalalgia 31(6):671–682, doi:10.1177/0333102410391489CrossRefPubMed
22.
Eggington S, Valldeoriola F, Chaudhuri KR, Ashkan K, Annoni E, Deuschl G (2014) The cost-effectiveness of deep brain stimulation in combination with best medical therapy, versus best medical therapy alone, in advanced Parkinson's disease. J Neurol 261(1):106–116, doi:10.1007/s00415-013-7148-zCrossRefPubMedCentralPubMed
23.
Taylor RS, Ryan J, O'Donnell R, Eldabe S, Kumar K, North RB (2010) The cost-effectiveness of spinal cord stimulation in the treatment of failed back surgery syndrome. Clin J Pain 26(6):463–469, doi:10.1097/AJP.0b013e3181daccecCrossRefPubMed
24.
Bond M, Mealing S, Anderson R, Elston J, Weiner G, Taylor RS, Hoyle M, Liu Z, Price A, Stein K (2009) The effectiveness and cost-effectiveness of cochlear implants for severe to profound deafness in children and adults: a systematic review and economic model. Health Technol Assess 13(44):1–330, doi:10.3310/hta13440CrossRef
25.
WHO (2003) Making choices in health: WHO guide to cost-effectiveness analysis. World Health Organization, Geneva
26.
Personal communication. Information provided by Autonomic Technologies, Inc (ATI) (2014).
27.
Metadata
Title
Cost-effectiveness of stimulation of the sphenopalatine ganglion (SPG) for the treatment of chronic cluster headache: a model-based analysis based on the Pathway CH-1 study
Authors
Jan B. Pietzsch
Abigail Garner
Charly Gaul
Arne May
Publication date
01-12-2015
Publisher
Springer Milan
Published in
The Journal of Headache and Pain / Issue 1/2015
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI
https://doi.org/10.1186/s10194-015-0530-8

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