Exploratory cost-effectiveness analysis of cardiac resynchronization therapy with systematic device optimization vs....

Area of Science:

• Health Economics
• Cardiovascular Medicine
• Medical Device Optimization

Background:

• Cardiac resynchronization therapy (CRT) optimization shows improved clinical benefits.
• This study evaluates the cost-effectiveness of systematically optimized (SO) versus non-systematically optimized (NSO) CRT strategies.

Purpose of the Study:

• To compare the cost-effectiveness of SO CRT (≥3 times/year) versus NSO CRT (<3 times/year) over a 5-year period.
• To analyze the economic impact from a payer's perspective, considering both CRT-P and CRT-D devices.

Main Methods:

• A longitudinal cohort model was developed using post-hoc data from 199 CRT-P patients (CLEAR study).
• Incremental Cost-Effectiveness Ratio (ICER) per Quality Adjusted Life Year (QALY) was the primary economic outcome.
• Sensitivity analysis was performed to assess data uncertainty and predict outcomes for CRT-D therapy.

Main Results:

• At 1 year, ICERs for SO CRT-P versus NSO CRT-P ranged from €22,226 to €26,977.
• The SO method is cost-effective from 1 year onwards, based on a Willingness-To-Pay of €30,000 per QALY.
• Systematic optimization of CRT-D may improve cost-effectiveness by 27-30% across analyzed countries within 5 years.

Conclusions:

• Systematic optimization of cardiac resynchronization therapy demonstrates promising health economic benefits.
• These findings suggest SO CRT is a valuable strategy for healthcare systems, though further confirmation is needed.