Advice

Expert comments

Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 3 experts were familiar with the technology and 1 had used it before. This expert was also involved in research related to the technology.

Level of innovation

All of the experts were familiar with spinal cord stimulation and all agreed that differential target multiplexed spinal cord stimulation (DTM SCS) is a minor variation of traditional spinal cord stimulation. The experts disagreed about whether DTM SCS can replace conventional spinal cord stimulation. The experts who felt it could replace standard care acknowledged its additional programming options. All experts were familiar with alternative spinal cord stimulation approaches, but none were aware of any technologies with the same mechanism of action (simultaneously targeting multiple targets in the spinal cord).

Potential patient impact

The experts agreed that the patient benefits include better pain relief and therefore improved quality of life. One expert estimated that about 100 to 300 people per year would be eligible for DTM SCS. The other 2 experts disagreed about the proportion of people who would be eligible for an intervention with the technology. One expert said that only 30% of the people who currently access spinal cord stimulation would be eligible for this therapy, whereas the other stated 100%. One expert expressed concern that despite NICE guidelines, less than 1% of people with intractable neuropathic pain have spinal cord stimulation.

Potential system impact

All 3 experts thought that the costs of using DTM SCS would be about the same as for conventional spinal cord stimulation. They also considered that there would be no need for a change in existing facilities in order to accommodate DTM SCS. All experts thought that training would be needed for the clinicians and hospital nurses only in relation to using and programming the external programmer. The experts estimated that a minority of specialised hospitals would be carrying out the procedure.

General comments

The experts felt that there are no safety concerns specific to DTM SCS that would be different from those for standard spinal cord stimulation. All experts suggested that research with outcome measures such as EQ‑5D and SF36 would be beneficial. Two experts acknowledged that the UK has a National Neuromodulation Registry, where all people having spinal cord stimulation should be entered. Another expert noted that there is an unequal spread of manufacturer devices used in different hospitals despite equal efficacy and costing. They attributed this to clinician preferences of certain devices and companies.