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Cost-effectiveness of enhanced external counterpulsation (EECP) for the treatment of stable angina in the United Kingdom

Published online by Cambridge University Press:  15 April 2010

Claire McKenna ,
Neil Hawkins ,
Karl Claxton ,
Catriona McDaid ,
Sara Suekarran ,
Kate Light ,
Michael Chester ,
John G. F. Cleland ,
Nerys Woolacott  and
Mark Sculpher
Claire McKenna
Affiliation:
University of York
Neil Hawkins
Affiliation:
University of York
Karl Claxton
Affiliation:
University of York
Catriona McDaid
Affiliation:
University of York
Sara Suekarran
Affiliation:
University of York
Kate Light
Affiliation:
University of York
Michael Chester
Affiliation:
Liverpool Hope University
John G. F. Cleland
Affiliation:
Castle Hill Hospital and University of Hull
Nerys Woolacott
Affiliation:
University of York
Mark Sculpher
Affiliation:
University of York
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Abstract

Objectives: The objective of this study is to assess the cost-effectiveness of enhanced external counterpulsation (EECP) compared with no treatment as additional therapy to usual care for the treatment of chronic stable angina from the perspective of the UK National Health Service.

Methods: The study design was a systematic review of published evidence, use of expert clinical opinion, and decision analytic cost-effectiveness model. The systematic review was conducted and statistical methods used to synthesize the effectiveness evidence from randomized control trials. Formal methods were used to elicit opinion from clinical experts where no evidence was available. These provide informed “priors” on key model parameters. A decision analytic model was developed to assess the costs and health consequences associated with the primary outcome of the trials over a lifetime time horizon. The main outcome measures were costs from a health service perspective and outcomes measured as quality-adjusted life-years (QALYs).

Results: The incremental cost-effectiveness ratio of EECP was £18,643 for each additional QALY, with a probability of being cost-effective of 0.44 and 0.70 at cost-effectiveness thresholds of £20,000 and £30,000 per QALY gained, respectively. Results were sensitive to the duration of health-related quality of life (HRQoL) benefits from treatment.

Conclusions: The long-term maintenance of HRQoL benefits of EECP is central to the estimate of cost-effectiveness. The results from a single randomized control trial do not provide firm evidence of the clinical or cost-effectiveness of EECP in stable angina. Long-term follow-up trials assessing quality of life from EECP are required.

Keywords

Cost-effectiveness analysisCardiovascular diseases
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 26 , Issue 2 , April 2010 , pp. 175 - 182
Copyright
Copyright © Cambridge University Press 2010

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