Spinal Cord Stimulation is not Cost-effective for Non-surgical Management of Critical Limb Ischaemia

Klomp, H.M.; Steyerberg, E.W.; van Urk, H.; Habbema, J.D.F.; for the ESES Study Group,

doi:10.1016/j.ejvs.2005.11.013

« Previous Next »European Journal of Vascular & Endovascular Surgery
Volume 31, Issue 5 , Pages 500-508, May 2006

Spinal Cord Stimulation is not Cost-effective for Non-surgical Management of Critical Limb Ischaemia

H.M. Klomp
- Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Public Health, Centre for Clinical Decision Sciences, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands
- Corresponding author. H.M. Klomp, MD, HOD, Department of Surgery, Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands.
E.W. Steyerberg
- Department of Public Health, Centre for Clinical Decision Sciences, Erasmus University Medical Centre, Rotterdam, The Netherlands
H. van Urk
- Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
J.D.F. Habbema
- Department of Public Health, Centre for Clinical Decision Sciences, Erasmus University Medical Centre, Rotterdam, The Netherlands
for the ESES Study Group

Accepted 9 November 2005. published online 04 January 2006.

Abstract

Objective

To quantify the costs of treatment in critical limb ischaemia (CLI) and to compare costs and effectiveness of two treatment strategies: spinal cord stimulation (SCS) and best medical treatment.

Methods

One hundred and twenty patients with CLI not suitable for vascular reconstruction were randomised to either SCS in addition to best medical treatment or best medical treatment alone. Primary outcomes were mortality, amputation and cost. Cost analysis was based on resources used by patients for 2 years after randomisation. Both medical and non-medical costs were included.

Results

Patient and limb survival were similar in the two treatment groups. Costs of in-hospital-stay and institutional rehabilitation constituted the predominant part (±70%) of the total costs of medical care in CLI. Cost of SCS-implantation and complications (€7950 per patient) exceeded by far cost due to amputation procedures (€410 per patient). The total costs of treatment were €36,600 per patient over 2 years for the SCS-group vs. €28,700 for best medical treatment alone (28% higher for SCS-group, p=0.009).

Conclusions

Total costs of treatment in CLI are high. Major components are hospital and rehabilitation costs. In contrast to recent reviews, there were no long-term benefits of SCS-treatment. Therefore, cost-effectiveness is reduced to cost-minimisation and SCS-treatment is considerably more expensive than best medical treatment.

Keywords: Cost analysis, Cost-effectiveness, Critical limb ischaemia, Spinal cord stimulation, Electrical stimulation, Meta-analysis, Peripheral vascular disease, Prognosis, Risk factors, Survival, Trials