Il costo della sindrome da fallimento chirurgico spinale (failed back surgery syndrome, FBSS) nei pazienti con indicazione a impianto per neurostimolazione midollare in Italia

Objective: To assess the costs and clinical condition of Failed Back Surgery Syndrome (FBSS) for patients eligible for Spinal Cord Stimulation (SCS) in Italy. Methods: A multicentre, retrospective data collection with a maximum time horizon of 12 months was developed. Nine Italian Centers experienced in SCS were involved enrolling 80 patients. Use and costs of healthcare and non-healthcare resources, clinical condition and HR-QoL data were collected through specific questionnaires submitted to patients. Mean monthly costs (EUR 2008) were evaluated according to three perspectives: Patient, National Healthcare System (NHS) and Society. Results: A strong impairment in baseline HR-QoL was documented. Mean utility score was 0.07 (general UK population: 0.70). According to the Oswestry questionnaire, 44% of patients were crippled and 39% severely disabled. All SF-36 dimensions were worse than in normal population. To treat FBSS, monthly expenditure per patient was equal to €177.34, €221.12 and €1,046.12 from the perspectives of Patient, NHS and Society, respectively. Productivity losses accounted for 62% of the societal total costs, while hospitalizations explained 28% of the costs sustained by the NHS. From the patient perspective, themain cost drivers were home care (27%) and travel expenses (26%). Conclusions: This Cost-of-Illness analysis confirms FBSS as a disabling and costly disease.