Cost-Effectiveness of Adding Cardiac Resynchronization Therapy to an Implantable Cardioverter-Defibrillator Among
Annals of Internal Medicine
|August 25, 2015
Summary
Adding Cardiac Resynchronization Therapy with a defibrillator (CRT-D) to an implantable cardioverter-defibrillator (ICD) is cost-effective for patients with mild heart failure. CRT-D offers improved life expectancy and quality-adjusted life-years compared to ICD alone.
Area of Science:
- Cardiology
- Health Economics
- Medical Device Technology
Background:
- Cardiac Resynchronization Therapy (CRT) is proven to reduce mortality and heart failure hospitalizations in patients with mild heart failure.
- The study focuses on patients with specific cardiac conditions: left ventricular systolic dysfunction, prolonged intraventricular conduction, and mild heart failure symptoms (NYHA class I or II).
Purpose of the Study:
- To evaluate the cost-effectiveness of combining CRT with an implantable cardioverter-defibrillator (CRT-D) versus using an implantable cardioverter-defibrillator (ICD) alone.
- The comparison is specifically for elderly patients (≥65 years) with reduced left ventricular ejection fraction (LVEF ≤30%) and prolonged QRS duration (≥120 ms).
Main Methods:
- A Markov decision model was employed to simulate patient outcomes over a lifetime horizon.
- Data sources included clinical trials, registries, Medicare claims data, and CDC life tables.
- Key outcome measures were life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).
Main Results:
- CRT-D therapy increased life expectancy by 1 year (9.8 vs. 8.8 years) and QALYs by 1 year (8.6 vs. 7.6 years) compared to ICD alone.
- The base-case analysis showed an incremental cost-effectiveness ratio (ICER) of $61,700 per QALY gained for CRT-D.
- Sensitivity analyses indicated that the cost-effectiveness of CRT-D is sensitive to the magnitude of mortality reduction, device costs, battery longevity, and patient age.
Conclusions:
- CRT-D is considered economically attractive compared to ICD alone for patients with NYHA class II symptoms, provided a mortality benefit is anticipated.
- Limitations include reliance on a single trial for mortality reduction estimates and limited data for NYHA class I patients, making their cost-effectiveness uncertain.
- Further research is needed to clarify the cost-effectiveness of CRT-D in patients with very mild (NYHA class I) heart failure symptoms.
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