Table 43:

Scenario Analysis Results, Cluster Headache

Strategy	Average total cost, $	Incremental cost, $a,b	Average total effect, QALYs	Incremental effect, QALYsb,c	ICER, $/QALYb
Reference case	Standard care: 2,516 nVNS: 7,833	5,317	Standard care: 0.4996 nVNS: 0.6941	0.1945	27,338
1a: Cost of the nVNS device reduced by 25%	Standard care: 2,508 nVNS: 6,241	3,733	Standard care: 0.4977 nVNS: 0.6894	0.1918	19,470
1b: Cost of the nVNS device increased by 25%	Standard care: 2,513 nVNS: 9,424	6,910	Standard care: 0.4987 nVNS: 0.6910	0.1924	35,925
3: nVNS provided free for the first 93 d	Standard care: 2,512 nVNS: 5,631	3,119	Standard care: 0.4977 nVNS: 0.6904	0.1927	16,187
4: Change in the clinical pathway	Standard care: 2,415 nVNS: 7,737	5,321	Standard care: 0.4959 nVNS: 0.6900	0.1940	27,424
5a: Time horizon reduced to 6 mo	Standard care: 1,163 nVNS: 3,620	2,457	Standard care: 0.2306 nVNS: 0.3203	0.0897	27,397
5b: Time horizon extended to 2 y (1.5% discount on costs and effects)	Standard care: 4,984 nVNS: 14,741	9,757	Standard care: 0.9879 nVNS: 1.372	0.3848	25,356
6: Changes in quality of life in the nVNS arm for people with cluster headache	Standard care: 2,513 nVNS: 7,838	5,325	Standard care: 0.4977 nVNS: 0.6655	0.1578	33,738
7: Response-dependent treatment continuation beyond 3 mo (60% nonresponder rate, Gaul 201553)d	Standard care: 2,514 nVNS: 5,376	2,862	Standard care: 0.4990 nVNS: 0.6040	0.1050	27,267
8: Reduction in acute medication use by people with cluster headache (assuming 0% reduction)	Standard care: 2,512 nVNS: 8,882	6,369	Standard care: 0.4985 nVNS: 0.6923	0.1938	32,866
9: Sumatriptan nasal spray to replace sumatriptan injections in people with cluster headache	Standard care: 1,640 nVNS: 8,010	6,369	Standard care: 0.4969 nVNS: 0.6896	0.1927	33,061
10: Publicly available Canadian costs for nVNS device used	Standard care: 2,512 nVNS: 4,063	1,552	Standard care: 0.4981 nVNS: 0.6927	0.1946	7,973

All costs are expressed in 2023 CAD.

Abbreviations: ICER, incremental cost-effectiveness ratio; nVNS, noninvasive vagus nerve stimulation; QALY, quality-adjusted life-year.

^aIncremental cost = average cost (nVNS with standard care) - average cost (standard care alone).

^bResults may appear inexact due to rounding. Changes in effectiveness outcomes (QALYs) may be present when scenarios address only costs, due to the probabilistic nature of our model.

^cIncremental effect = (nVNS with standard care) - average effect (standard care alone).

^dNonresponder rates were calculated as 1 - the responder rate identified in the randomized, controlled trial.