Is combined resynchronisation and implantable defibrillator therapy a cost-effective option for left ventricular...

Area of Science:

• Cardiology
• Health Economics

Background:

• Left ventricular dysfunction and prolonged QRS intervals are key indicators for cardiac resynchronisation therapy (CRT) and implantable cardioverter-defibrillators (ICDs).
• Evaluating the cost-effectiveness of combined CRT and ICD therapy is crucial for optimizing healthcare resource allocation in heart failure management.

Purpose of the Study:

• To assess the cost-effectiveness of combined CRT and ICD therapy versus other treatment strategies for left ventricular dysfunction.
• To identify patient subgroups that may benefit most from combined CRT and ICD therapy.

Main Methods:

• A Markov model-based economic evaluation was conducted within the UK National Health Service (NHS).
• The study simulated a cohort of patients with NYHA class III and IV heart failure, left ventricular systolic dysfunction, and prolonged QRS intervals.
• The primary outcome measure was the cost per quality-adjusted life year (QALY) gained over a patient's lifetime.

Main Results:

• Resynchronisation therapy alone was found to be cost-effective compared to optimal medical therapy, with an incremental cost-effectiveness ratio (ICER) of £16,735 per QALY gained.
• Combined CRT and ICD therapy showed a higher ICER of £40,160 per QALY gained compared to CRT alone, with only a 26% probability of being cost-effective at a willingness-to-pay threshold of £30,000.
• Resynchronisation therapy alone emerged as the most cost-effective treatment strategy among the three evaluated options (medical treatment, CRT alone, and combined CRT-ICD).

Conclusions:

• Combined resynchronisation and implantable defibrillator therapy is not a cost-effective strategy for patients with left ventricular dysfunction.
• Resynchronisation therapy alone represents the most cost-effective policy for this patient population.
• Combined devices may offer greater cost-effectiveness in specific subgroups, such as younger patients or those at high risk of sudden cardiac death who are candidates for CRT.