Hospital utilization and costs for spinal cord stimulation compared with enhanced external counterpulsation for refractory angina pectoris

Authors

  • Susanne M. Bondesson RN,

    Corresponding author
    1. PhD student in Health Care Science, Department of Medicine, Kristianstad University, Kristianstad, Sweden and Department of Health Sciences Lund, Lund University, Sweden
      Susanne M. Bondesson, Department of Medicine, Kristianstad Hospital, Kristianstad SE-291 85, Sweden, E-mail: susanne.bondesson@med.lu.se
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  • Ulf Jakobsson RN,

    1. Associate professor in Health Care Science, Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Lund, Sweden and Centre of Primary Health Care Research, Faculty of Medicine, Lund University, Lund, Sweden
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  • Lars Edvinsson MD,

    1. Professor in Clinical Science, Department of Emergency Medicine, Clinical Sciences Lund, Lund University, Lund, Sweden
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  • Ingalill Rahm Hallberg RN

    1. Professor in Health Care Science, Department of Health Sciences Lund, Lund University, Lund, Sweden
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  • The work was carried out at the Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden.

Susanne M. Bondesson, Department of Medicine, Kristianstad Hospital, Kristianstad SE-291 85, Sweden, E-mail: susanne.bondesson@med.lu.se

Abstract

Rationale, aims and objectives  The aim of this study was to compare acute hospital utilization and costs for patients with refractory angina pectoris undergoing spinal cord stimulation (SCS) versus enhanced external counterpulsation (EECP).

Method  Seventy-three persons were included in this register study. The acute hospital utilization and costs for SCS and EECP were followed over a period from 12 months before treatment to 24 months after treatment using Patient Administrative Support in Skåne for publicly organized care.

Results  SCS was significantly more expensive than EECP (P < 0.001). Both SCS and EECP entailed fewer days of hospitalization for coronary artery disease in the 12-month follow-up compared with the 12 months preceding treatment. Patients treated with EECP showed an association between reduced hospital admissions and an improved Canadian Cardiovascular Society classification class compared with 1 year before treatment. A significant reduction in cost was seen in both the SCS group (P = 0.018 and P = 0.001, respectively) and the EECP group (P = 0.002 and P = 0.045, respectively) during 12 and 24 months of follow-up compared with before treatment. There were no significant differences between the groups for hospitalization days or admissions, including costs, at the different follow-ups.

Conclusions  Cost-effective treatment modalities such as SCS and EECP are valuable additions to medical and revascularization therapy in patients with refractory angina pectoris. Pre-existing conditions and the patient's preferences should be taken in consideration when clinicians choose between treatments for this group of patients.

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