Electric spinal cord stimulation (SCS) in the treatment of angina pectoris: A cost-utility analysis

For the last 15 years electric spinal cord stimulation (SCS) has been employed in patients with confirmed ischemic heart disease who suffer from refractory angina pectoris despite maximum medical/surgical treatment. The purpose of this investigation was to assess not only the economic consequences of SCS treatment (cost-utility analysis) but also altered quality of life in SCS patients. The retrospective study includes 18 consecutive patients, six women and 12 men, with an average age of 56.5 years (range 50-68), submitted to implantation of a SCS system at Odense University Hospital. Before implantation of the SCS system, the patients were in a transcutaneous electric nerve stimulation (TENS) treatment 2-11 months. At the submission all patients were in New York Heart Association functional group III/IV. The results are based on cost data from the year prior to start of TENS treatment compared with the year after implantation of the SCS system. Medical records of the patients were examined and data concerning use of general practitioners and emergency services were collected from a nationwide database. Quality of life data were collected using identical questionnaires (perception of pain, mobility, function in daily life, and physical activity) related to the period immediately before start of the TENS treatment and one year after SCS implant. Savings were found at hospital level (reduction in number of admissions) and for non-hospital related expenses (such as medication and visits at general practitioners). In addition, improvements were registered in all respects which constituted assessment of the quality of life of the patients. The study is a repetition of a similar analysis with identical results made in 1990 and including the 16 first angina pectoris patients treated with SCS at Odense University Hospital. SCS is effective in reducing hospital and non-hospital related expenses and improving quality of life of the patients. SCS is a simple treatment for the patient to use. The implantation technique is not more invasive than permanent cardiac pacing. The decisive part of the procedure is the insertion of the electrode and follow-up with support and adjustments of the stimulation.