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EECP - Information for Doctors


Patients who may benefit from EECP include:

Contraindications

Precautions

Is EECP cost-effective?

How to refer?


Patients who may benefit from EECP include:

1. Patients with angina or angina equivalent symptoms who:

2. Have co-morbid conditions that increase the risk of revascularization procedures

3.  Elderly patients at high risk for morbidity/mortality from PCI/CABG


EECP Decision Making Flow Chart


Contraindications                                                                                           Top

The clinic and consultant cardiologist will review contraindications and suitability for EECP


Precautions

The clinic and consultant cardiologist will review these factors prior to EECP


Is EECP cost-effective?                                                                           Top


To provide a reference point for cost-effectiveness, the National Institute for Health and Clinical Excellence (NICE) uses a threshold cost per QALY (quality adjusted life years) as a marker for the length and quality of life that is increased per pound spent of around £20,000-£30,000 to determine whether an intervention represents good value for money in the NHS.


A draft publication of the cost effect of EECP has recently been produced, following commission from the HTA which forms part of the assessment process used by NICE.  The base cost effectiveness analysis of EECP falls below the above cost threshold, making EECP a cost effective treatment.


This is summarised in the HTA report, “Based on current evidence, EECP appears cost-effective for this patient population (angina patients  as in MUST-EECP trial), but there is significant value to future research informing the long-term maintenance of quality of life benefits from EECP. “


At this time there is a significant body of evidence showing long term reduction in the severity of angina symptoms using functional scores such as the Canadian Classification (see CCS section) over several years. Specific data using quality of life questionnaires has only been gathered up to one year after EECP.


Longer term quality of life data has been recorded by NHS units in the UK which is demonstrating a lasting improvement in  quality of life scores and a significant reduction in cardiac admissions post EECP.


A baseline analysis of the cost effectiveness of EECP therefore was determined by HTA to be £18,600 per additional QALY gained, which is certainly cost effective based on NICE criteria.


This is also based on just 12 patients being treated per bed per year, and given greater use of EECP the efficiency will increase and cost of the EECP treatment will reduce, further increasing the cost effect of treatment.


The cost effect is also anticipated to further improve as evidence is gathered directly supporting that EECP benefit to quality of life is sustained over longer periods of time, with a projected cost of just £5,831 per QALY as an incredibly cost effective  best case scenario. Indirect measures of improved quality of life already support this favourable cost effectiveness and the specific long-term quality of life data now needs to be gathered.


Studies from the USA, where EECP is much more widely utilised and funded via Medicare, support high level of cost effectiveness with a reported cost of just $3126 US dollars per QALY (quality adjusted life year) gained  following EECP treament.


In comparison to this, the benefit of  various drug-eluting cardiac stents have recently been assessed by NICE which showed the cost for various stent insertion procedures to be on average £120,000 - 180,000 per incremental QALY gained. (click here to link to full NICE guidance on drug eluting stents).


                                                                                                                                             


How to refer?                                                                                           Top


We accept referrals from:


GP’s, Cardiologists, and patient self–referrals and perform EECP for PCT and privately funded patients.


We will arrange a free pre-assessment.


Referrals &  enquiries to:


The Dove Clinic for Integrated Medicine

The Old Brewery

High Street

Twyford

Winchester

Hants, SO21 1RG

Tel:  01962 717060


Email: secretaries@doveclinic.com


For further information regarding EECP, to arrange further discussion or for clinical enquiries please contact Dr Richard Fuller at The Dove Clinic.


Email:  richard.fuller@doveclinic.com

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