Related Experiment Video
Updated: Jan 20, 2026
Translational Rabbit Model of Chronic Cardiac Pacing
Published on: January 6, 2023
Economic value and cost-effectiveness of biventricular versus right ventricular pacing: results from the BLOCK-HF
Eugene S Chung1, Martin G St John Sutton2, Stuart Mealing3
1The Carl and Edyth Lindner Research Center, The Christ Hospital Heart and Vascular Center , Cincinnati , OH , USA.
Insights
Biventricular (BiV) pacing improves survival and quality of life for heart failure patients with atrioventricular (AV) block compared to right ventricular (RV) pacing. This advanced pacing strategy is cost-effective for Medicare, justifying its upfront costs.
Area of Science:
- Cardiology
- Health Economics
- Medical Device Technology
Background:
- Biventricular (BiV) pacing shows superior clinical and structural outcomes over right ventricular (RV) pacing in heart failure (HF) patients with atrioventricular (AV) block and reduced left ventricular ejection fraction (LVEF).
- The BLOCK-HF trial established the efficacy of BiV pacing in this patient cohort.
- Cost-effectiveness of BiV pacing versus RV pacing in this specific population requires detailed economic evaluation.
Purpose of the Study:
- To investigate the cost-effectiveness of biventricular (BiV) pacing compared to right ventricular (RV) pacing in patients with atrioventricular (AV) block and reduced left ventricular ejection fraction (LVEF).
- To evaluate the economic value from a US Medicare payer perspective.
- To compare the long-term clinical and economic benefits of different pacing strategies.
Main Methods:
- Statistical models predicted all-cause mortality and New York Heart Association (NYHA) Class distribution over time using BLOCK-HF trial data.
- Heart failure (HF)-related healthcare utilization rates were analyzed.
- A proportion-in-state model calculated the incremental cost-effectiveness ratio (ICER) from the Medicare payer perspective.
Main Results:
- BiV pacing increased predicted survival by 10.9% (7.52 years) compared to RV pacing (6.78 years).
- BiV pacing yielded 0.41 additional quality-adjusted life years (QALYs) at an incremental cost of $12,537, resulting in a base-case ICER of $30,860/QALY.
- Patients receiving BiV-D devices showed greater gains (0.84 years) than BiV-P recipients (0.49 years) compared to dual-chamber pacemakers.
Conclusions:
- Biventricular (BiV) pacing significantly improves survival and attenuates heart failure (HF) progression in patients with atrioventricular (AV) block compared to right ventricular (RV) pacing.
- The incremental cost-effectiveness ratios (ICERs) for BiV pacing were consistently below the US acceptability threshold of $50,000/QALY.
- From a US Medicare perspective, the additional upfront cost of BiV pacing is justified by the improved long-term outcomes and economic benefits.
Abstract:
Aims: The Biventricular vs Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK-HF) demonstrated that biventricular (BiV) pacing resulted in better clinical and structural outcomes compared to right ventricular (RV) pacing in patients with atrioventricular (AV) block and reduced left ventricular ejection fraction (LVEF; ≤50%). This study investigated the cost-effectiveness of BiV vs RV pacing in the patient population enrolled in the BLOCK-HF trial. Methods: All-cause mortality, New York Heart Association (NYHA) Class distribution over time, and NYHA-specific heart failure (HF)-related healthcare utilization rates were predicted using statistical models based on BLOCK-HF patient data. A proportion-in-state model calculated cost-effectiveness from the Medicare payer perspective. Results: The predicted patient survival was 6.78 years with RV and 7.52 years with BiV pacing, a 10.9% increase over lifetime. BiV pacing resulted in 0.41 more quality-adjusted life years (QALYs) compared to RV pacing, at an additional cost of $12,537. The "base-case" incremental cost-effectiveness ratio (ICER) was $30,860/QALY gained. Within the clinical sub-groups, the highest observed ICER was $43,687 (NYHA Class I). Patients receiving combined BiV pacing and defibrillation (BiV-D) devices were projected to benefit more (0.84 years gained) than BiV pacemaker (BiV-P) recipients (0.49 years gained), compared to dual-chamber pacemakers. Conclusions: BiV pacing in AV block patients improves survival and attenuates HF progression compared to RV pacing. ICERs were consistently below the US acceptability threshold ($50,000/QALY). From a US Medicare perspective, the additional up-front cost associated with offering BiV pacing to the BLOCK-HF patient population appears justified.
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