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Cost-impact analysis of baroreflex activation therapy in chronic heart failure patients in the United States
John Bisognano1, John E Schneider2, Shawn Davies3
1University of Rochester Medical Center, Rochester, NY, USA.
Insights
Baroreflex activation therapy plus guideline-directed therapy (BAT+GDT) is initially more expensive but becomes cost-effective for heart failure patients within three years. This approach reduces hospitalizations and the need for advanced procedures, offering long-term savings.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Biomedical Engineering
Background:
- Heart failure (HF) with reduced ejection fraction (HFrEF) and NYHA Class III/II symptoms necessitate advanced treatment strategies.
- Baroreflex activation therapy (BAT) utilizes an implantable device to stimulate carotid artery baroreceptors, aiming to restore autonomic balance and cardiovascular homeostasis.
- The BeAT-HF trial investigated the safety and efficacy of BAT in HF patients.
Purpose of the Study:
- To evaluate the cost-effectiveness of baroreflex activation therapy plus guideline-directed therapy (BAT+GDT) compared to guideline-directed therapy (GDT) alone for HFrEF patients.
- To model the economic impact of BAT+GDT versus GDT alone from a U.S. healthcare payer perspective over a three-year period.
Main Methods:
- A cost-impact model was developed using 6-month data from the BeAT-HF trial and existing literature.
- Extrapolation of HF hospitalization rates was based on observed improvements in NT-proBNP levels.
- The model compared BAT+GDT to GDT alone, considering device, implantation, hospitalization, and late-stage procedure costs.
Main Results:
- Initially, BAT+GDT incurred an additional cost of $29,526 per patient due to device and implantation expenses.
- After three years, BAT+GDT was projected to be $9,521 less expensive per patient than GDT alone.
- Cost savings were attributed to reduced HF hospitalizations, non-HF cardiovascular hospitalizations, and fewer LVADs/heart transplants.
Conclusions:
- BAT+GDT transitions from a higher initial cost to a more cost-effective strategy within 1-3 years compared to GDT alone.
- The therapy offers potential for significant long-term healthcare cost savings in HFrEF management.
- Future updates incorporating longer-term BeAT-HF trial data will refine the cost-effectiveness projections.
Background:
The study evaluated the cost of baroreflex activation therapy plus guideline directed therapy (BAT + GDT) compared to GDT alone for HF patients with reduced ejection fraction and New York Heart Association Class III or II (with a recent history of III). Baroreflex activation therapy (BAT) is delivered by an implantable device that stimulates the baroreceptors through an electrode attached to the outside of the carotid artery, which rebalances the autonomic nervous system to regain cardiovascular (CV) homeostasis. The BeAT-HF trial evaluated the safety and effectiveness of BAT.
Methods:
A cost impact model was developed from a U.S. health care payer or integrated delivery network perspective over a 3-year period for BAT + GDT versus GDT alone. Expected costs were calculated by utilizing 6-month data from the BeAT-HF trial and existing literature. HF hospitalization rates were extrapolated based on improvement in NT-proBNP.
Results:
At baseline the expected cost of BAT + GDT were $29,526 per patient more than GDT alone due to BAT device and implantation costs. After 3 years, the predicted cost per patient was $9521 less expensive for BAT + GDT versus GDT alone due to lower rates of significant HF hospitalizations, CV non-HF hospitalizations, and resource intensive late-stage procedures (LVADs and heart transplants) among the BAT + GDT group.
Conclusions:
BAT + GDT treatment becomes less costly than GDT alone beginning between years 1 and 2 and becomes less costly cumulatively between years 2 and 3, potentially providing significant savings over time. As additional BeAT-HF trial data become available, the model can be updated to show longer term effects.
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