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Published on: February 28, 2012
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
Summary
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.
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