Abstract
Background: Repeat hospitalizations represent significant direct costs of care in patients (pts) with refractory angina. Enhanced external counterpulsation (EECP) is effective in treating coronary pts with disabling angina, who are not candidates for revascularization, and have limited treatment options. This study evaluated the cost savings in hospitalizations using EECP therapy. Methods: Annual EECP hospitalization cost savings/pt was calculated by the product of estimated hospitalization and physician charge based on a sample-size weighted average of Healthcare Cost and Utilization Project Nationwide Inpt Sample database and the reduction of hospitalizations/year after subtracting the cost of EECP. Pre- and post- EECP hospitalization rates were derived using data from the International EECP Pt Registry. The prevalence of refractory angina in the US in 2008 was estimated from the AHA Heart Disease and Stroke Statistics, heartstats.org, and the Incidence and Prevalence Database. Results: The annual pre-EECP treatment hospitalization rate for 1,015 refractory angina pts with 95% in Canadian Cardiovascular Society (CCS) functional class III and IV was 1.85 /pt/year. 92% of these pts had prior PCI or CABG with multivessel coronary disease and were no longer candidates for revascularization. EECP therapy was effective in reducing the proportion of CCS class III and IV pts to 21% at 1-year follow-up. Post-EECP 23% of the pts were hospitalized with a mean of 1.4 ± 1.0 hospitalizations in the 1 year after EECP. The post-EECP hospitalization rate was 0.63/pt/year, giving a hospitalization rate reduction of 1.22/pt/year. The average hospitalization and physician charge in the US was $17,995, and the average EECP treatment cost was $4,880, yielding an annual cost savings/pt of $17,025. Estimates of total savings were calculated by the product of cost savings/pt and the low and high estimates of the incidence of refractory angina (low: 422,000 pts; high: 1,273,000 pts). This calculation translated the total annual hospitalization cost savings as a potential 7.185 billion to 21.673 billion dollars. Conclusions: Appropriate use of EECP in refractory angina pts could result in a substantial decrease in hospital costs at an attractive cost-effectiveness.
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