COST-EFFECTIVENESS ANALYSIS OF 48- VERSUS 24-HOUR METHYLPREDNISOLONE INTERVENTION IN SPINAL CORD INJURY PATIENTS

Traumatic spinal cord injury (SCI) is a devastating form of neurotrauma with extensive health care consequences for the patients, their families, and Society. The corticosteroid, methylprednisolone sodium succinate (MP) is the preferred acute intervention based on guidance established through multicentre randomized controlled trials. Still, clinical controversy about the risk-benefit profile surrounds the extended dose regimen of MP for 48 hours (48h-MP) versus the limited dose regimen of MP for 24 hours (24h-MP) in the acute care of SCI patients. Moreover, since there are no studies examining the cost-effectiveness of these interventions, the benefit of either dosing regimen to the health care burden, if any, is unknown.

Purpose: To evaluate the cost-effectiveness of 48h-MP compared with 24h-MP for the acute clinical management of traumatic SCI patients.

Method: A decision tree analysis was performed to determine the cost-effectiveness of 48h-MP versus 24h-MP. Motor improvement scores and complication frequencies, extracted from the Third National Acute Spinal Cord Injury Study (NASCIS III), and utility scores from an Australian cohort to calculate quality adjusted life years (QALY), were used to measure outcomes and effects in three survival phases post-injury. Uncertainty in our model parameters was measured with deterministic and probabilistic sensitivity analyses. Monte Carlo simulation, with a cohort of 1000 patients, was run to obtain distributions of the incremental cost-effectiveness ratio between the interventions.  Survival data, direct health care expenditures and complication costs associated with SCI and MP intervention for SCI were based on our review of epidemiological and survey data from the literature. Analyses were performed from the healthcare payer’s perspective, discounted at a rate of 4% annually with a lifetime horizon.

Result: 48h-MP dominates 24h-MP, providing higher QALYs at lower costs. The lower costs associated with 48h-MP intervention was $35,703 per patient lifecycle, when compared with 24h-MP patients. Sensitivity analyses showed that the magnitude of “motor-normal” function, at one year post-injury, could be exceedingly small in favour of the 48h-MP intervention, irrespective of the clinical complications associated with this dosing regimen.

Conclusion: 48h-MP is the cost-effective intervention for SCI in comparison to 24h-MP, wherein the former results in modestly improved motor function, an effect which is maintained up to at least one year post-injury.