Modelling the cost effectiveness of a potential new neck collar for patients with motor neurone disease

S Dixon, W Tindale, CJ McDermott, N Heron, A McCarthy, PJ Shaw, N Latimer

Abstract

Background: Patients with motor neurone disease (MND) suffer from reduced motility and strength of the neck muscles over time. This commonly results in difficulties with correct positioning for communicating, eating and breathing. There are a number of neck braces which available for MND patients, however they are inadequate for the majority of MND patients, and a new collar is set to be designed. This paper conducts a brief analysis of the potential cost effectiveness of such a collar.
Methods: A cost-utility analysis was undertaken using a simple three state Markov model of disease progression. The key input to this model were utilities from a small health valuation survey based around scenarios describing MND and the associated symptoms and limitation relating to reduced neck motility and strength. A scenario sensitivity analysis was used to identify the price at which new neck braces could be cost-effective given different effets on uptake and effectiveness.
Results: Four scenarios were examined that examined different impacts on rates of use of a neck brace and effectiveness of the new neck brace. For moderate effectiveness and no impact on non-use the maximum annual incremental collar cost to the NHS, using a funding threshold of £20,000 per quality adjusted life year, was £720. Adjusting this scenario for a large effect increases the maximum allowable cost to £960. Altering these two scenarios to include a large impact on rates of non-use produced maximum allowable costs of £800 and £1,040, respectively,
Conclusions: Our analysis suggests that there is considerable scope for a new neck brace for MND patients with moderate and severe neck pain to represent a cost effective use of NHS resources. Even with a brace costing around £1,000, it is possible that it will be cost-effective. However, these results should be interpreted with great caution: the potential brace has not yet reached the final design stage and although we do not assume in this analysis that it will prove adequate for all MND patients with neck weakness, we do assume that it provides a very substantial increase in adequacy rates (18% to 50% for moderate patients, and 0% to 30-50% for severe patients).