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The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable

Guiqing Yao1, Nick Freemantle, Melanie J Calvert

  • 1Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.

European Heart Journal
|November 18, 2006
PubMed

Insights

Cardiac resynchronization therapy (CRT-P) is cost-effective for heart failure patients. Adding an implantable cardioverter-defibrillator (CRT-ICD) to CRT-P also offers long-term value, improving outcomes and survival benefits.

Area of Science:

  • Cardiology
  • Health Economics
  • Medical Technology

Background:

  • Heart failure with cardiac dyssynchrony significantly impacts patient prognosis.
  • Pharmacological therapy alone may not sufficiently manage moderate to severe symptoms.
  • Cardiac resynchronization therapy (CRT-P) and implantable cardioverter-defibrillators (ICD) offer potential benefits.

Purpose of the Study:

  • To assess the cost-effectiveness of CRT-P versus medical therapy (MT) alone.
  • To evaluate the incremental cost-effectiveness of CRT-ICD plus MT compared to CRT-P plus MT.
  • To determine the cost per quality-adjusted life year (QALY) and life year gained.

Main Methods:

  • A Markov model with Monte Carlo simulation was employed.
  • Data from the CARE-HF trial informed patient characteristics and outcomes.
  • The COMPANION trial data was used to estimate the survival benefit of ICDs.
  • Lifetime simulations were conducted from a UK healthcare perspective.

Main Results:

  • CRT-P demonstrated cost-effectiveness compared to MT alone, with an incremental cost of €7538 per QALY gained.
  • The incremental cost-effectiveness of CRT-ICD compared to CRT-P was €47,909 per QALY gained.
  • Both QALY and life year gained metrics supported the cost-effectiveness of CRT interventions.

Conclusions:

  • Long-term CRT-P treatment is a cost-effective option for eligible heart failure patients.
  • CRT-ICD offers potential cost-effectiveness compared to CRT-P, particularly considering long-term survival benefits.
  • These findings support the integration of CRT devices in managing heart failure with dyssynchrony.
Abstract

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