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Economic analysis of a randomized trial of biventricular pacing in Canada
Judith D Bentkover1, Paul Dorian, Bernard Thibault
1Innovative Health Solutions Corp., Brookline, Massachusetts 02446, USA. jbentkover@ihsolutions.com
Insights
Cardiac resynchronization therapy (CRT) with an implantable cardiac defibrillator (ICD) reduces healthcare costs for heart failure patients. This approach offers significant savings in hospitalizations and medication expenses.
Area of Science:
- Cardiology
- Health Economics
Background:
- Congestive heart failure (CHF) affects 5% of Canadian adults, with significant mortality.
- Economic impacts of biventricular pacing for CHF are not well-documented.
Purpose of the Study:
- To analyze resource utilization and costs for CHF patients receiving ICDs versus ICDs with biventricular pacing (CRT).
Main Methods:
- The CART-HF study randomized 72 CHF patients (NYHA class II-IV) to ICD + CRT or ICD alone.
- Resource utilization (medications, visits, hospitalizations, adverse events, productivity) was tracked for 6 months post-treatment.
- Data were costed for Quebec and Ontario.
Main Results:
- CRT + ICD treatment resulted in lower per-patient costs than ICD alone in both Quebec and Ontario.
- Mean 6-month savings with biventricular therapy were CAD 2,420 in Quebec and CAD 2,085 in Ontario.
Conclusions:
- Savings in post-implant healthcare utilization (hospitalizations, medications) can offset CRT device and procedure costs.
- Biventricular pacing demonstrates a favorable economic profile in managing CHF.
Background:
Congestive heart failure (CHF) has been shown to affect 5% of the Canadian adult population, and leads to 9.5 deaths per 100 cardiac-related hospitalizations in Canada. The economic outcomes from biventricular pacing for heart failure are not well understood. This study analyzes resource utilization and related costs associated with CHF for patients who receive standard implantable cardiac defibrillators (ICDs) versus those who receive ICD plus biventricular pacing or cardiac resynchronization therapy (CRT).
Methods:
The Canadian analysis of resynchronization therapy in heart failure (CART-HF) study included 72 patients with New York Heart Association class II-IV CHF requiring an ICD. Patients were randomized to receive either ICD + CRT treatment or ICD treatment alone. Medical resource utilization data were collected for 6 months following treatment and were applied to representative costs for the provinces of Quebec and Ontario. Resource utilization was subcategorized into pharmacological therapy, physician visits, hospitalizations, adverse events, and productivity losses.
Results:
Post-treatment, per patient costs for the CRT + ICD treatment group were less than the follow-up costs for patients receiving ICD treatment only in each province. Mean savings for patients receiving biventricular therapy were CAD 2,420 dollars in Quebec and CAD 2,085 dollars in Ontario during the 6-month follow-up.
Conclusions:
These analyses indicate that savings in post-implant health-care utilization (hospitalizations and pharmacological therapy) can offset some of the device and procedural costs associated with CRT devices.
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