Evoke Spinal Cord Stimulator for managing chronic neuropathic or ischaemic pain

The technology described in this briefing is Evoke Spinal Cord Stimulator System. It is used for managing chronic neuropathic or ischaemic pain.

The innovative aspects are that Evoke uses a 'closed-loop' feedback control. It does this by recording activation of neural tissue and automatically adjusting stimulation to ensure it remains in the therapeutic range.

The intended place in therapy would be as a replacement or alternative to current open-loop (fixed-output) spinal cord stimulation therapy in people with leg and back pain.

The main points from the evidence summarised in this briefing are from 2 studies: a randomised controlled trial and an observational study, including a total of 184 adults with intractable back and leg pain. They show that Evoke is more effective than open-loop spinal cord stimulation in people with intractable back and leg pain.

Key uncertainties around the evidence are that there are no studies reporting the economic impact of Evoke.

The cost of Evoke ranges from £17,595 to £19,395 for the device. The trial phase cost ranges from £1,920 to £4,975. The resource impact would be comparable with standard care, which ranges from £13,726 to £22,418 for a rechargeable spinal cord stimulation system.