Comparison of Costs

Among the challenges confronting neurotechnology firms developing new products and therapies is obtaining reimbursement. Making this task more difficult is the fact that neurotech devices generally cost more than pharmaceuticals and many payers take a short-term view on the issue of relative cost-effectiveness.

Fortunately, neurotech firms and clinicians are beginning to fight back. We’re pleased to see several new economic studies that examine the long-term cost effectiveness of specific neuromodulation therapies compared to traditional medical management.

In an article published in the journal Colorectal Disease, A.A. van de Wilt from Maastricht University and colleagues reported results of their economic analysis of sacral neuromodulation for treating chronic constipation in children and adolescents. Their study looked at the cost-effectiveness of neuromodulation compared to more conservative treatments. They found that over a period of three years, mean cumulative costs for the neuromodulation patients was €17,789 compared to €7574 for the conservative treatment group. But the mean quality adjusted life years for the neuromodulation patients was 1.74, compared to 0.86 for the non-neuromodulation patients. The authors concluded that neuromodulation improves symptoms and quality of life at a reasonable cost.

In another article authors Jeffrey Voigt, Linda Carpenter from Brown, and Andrew Leuchter from UCLA compared the cost effectiveness of rTMS to antidepressant medications after a first treatment failure in major depressive disorder. Writing in the journal PLOS One, they concluded that rTMS was favorable both in terms of long-term costs and QALYs. An important issue in any economic comparison of neuromodulation to pharmaceutical interventions is how early in the course of illness the neuromodulation therapy begins. Needless to say, the earlier the use of neuromodulation, the better the prognosis for the patient—and the payer. Unfortunately, although private and government payers reimburse for rTMS, they generally require at least four pharmacological failures before they’ll reimburse for rTMS. This policy not only penalizes the patient by delaying the use of what may be the most successful therapy option. It also poisons the competitive outlook for neuromodulation therapies by relegating them to patient groups least likely to respond at all. But as the authors point out, in the case of depression, the payers would fare better financially if they allowed the use of neuromodulation after just one pharmacological failure.

It’s clearly in everyone’s interest to allow neuromodulation therapies to compete on a more level playing field with more conservative therapies. The result, we believe, would satisfy patients and taxpayers alike.

James Cavuoto
Editor and Publisher