Spinal Cord Stimulation for Long-term Treatment of Severe Angina Pectoris

What Does the Evidence Say?

Mats Börjesson; Paulin Andréll; Clas Mannheimer


Future Cardiol. 2011;7(6):825-833. 

In This Article

Cost–effectiveness of SCS in Severe Angina Pectoris

The annual cost of refractory angina pectoris, including direct and indirect costs has been estimated to be CAN $19,209 per patient in a Canadian study.[48] This is important, since the widespread use of SCS for the management of severe angina pectoris is dependent on favorable cost–effectiveness data.

The retrospective analysis of efficacy and cost-benefit of SCS, by Yu et al., 18 months after SCS implantation, analyzed the effects on CCS functional level and symptom relief (n = 24).[19] In the year postimplantation, the duration of hospitalization decreased significantly, and the total cost of the SCS implantation was recovered within 16 months after the procedure, which is well under the expected half-life of the device.[49] The conclusion was that SCS treatment was effective in preventing hospitalization and saving costs in hospital care.

In a 2-year follow-up study the cost–effectiveness of SCS was compared with CABG in the ESBY study.[49] Costs of hospital care, morbidity and causes of death after both treatments were assessed, together with the complications of SCS. The results showed that the patients randomized to SCS had fewer hospitalization days, both related to the primary intervention (mean 5 days compared with 11 days; p < 0.0001) and due to cardiac events (p < 0.05), compared with the patients randomized to CABG. When taking into account the cost of the primary intervention (SCS/CABG), hospital days and follow-up treatments, the total cost was lower per patient with SCS compared with CABG (€16,400 per patient versus €18,800 per patient). Thus, SCS was found to be a less expensive symptomatic treatment option for patients with severe angina pectoris, compared with CABG (p < 0.01).[49]

A clinical and cost–effectiveness analysis of the SPiRiT-trial was published in 2008,[50] showing that the probability of SCS being cost effective compared with PMR, over a 2-year period, was calculated to 30%. The authors concluded that further and longer studies are needed to select patients, suitable for SCS, that is, those who would benefit the most and therefore potentially make SCS more cost effective.

A comprehensive cost–effectiveness analysis of SCS for neuropathic pain and ischemic pain, including severe angina pectoris, was recently performed by the School of Health and Related Research (ScHARR) in Sheffield, UK.[47] The authors reviewed studies on efficacy, listed all healthcare and costs of the procedure in a UK setting. In addition, they used a model for their economical evaluation, based on a prospective observational study comparing the cost–effectiveness of CABG, PCI or conventional medical management.[51] Consecutive, unselected patients, who had undergone coronary angiography in the UK were recruited. A subgroup of 1740 of the original 4121 patients followed-up for 6 years, were found suitable for CABG, PCI or both, with 70% having a CCS class of III–IV (severe angina). The model then explores the costs and benefits added through pain relief over a 6-year period. All costs (medication, SCS implantation, PCI, CABG, follow-up and side-effects) were added, and the health economic outcomes, cost per life-year gained and cost per quality-adjusted life-years gained, were calculated for each treatment modality. The conclusions were that the most favorable economic profile for treatment with SCS is when compared with CABG in patients clinically appropriate to receive PCI and/or CABG.

In summary, SCS seems to be a cost effective treatment modality with a 'break-even' after approximately 15–16 months.[19,52] The foremost reason to the cost–effectiveness of SCS seems to be due to decreased hospital admissions.[16,19,49,52]


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.