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Cost-Effectiveness Ratio Analysis of LBBaP Versus BVP in Heart Failure Patients With LBBB
Shengchan Wang1, Siyuan Xue1, Zhixin Jiang1
1Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
Insights
Left bundle branch area pacing (LBBaP) is more cost-effective than biventricular pacing (BVP) for heart failure patients with left bundle branch block. LBBaP offers superior LVEF improvement and lower hospitalization costs, though further trials are needed.
Area of Science:
- Cardiology
- Medical Devices
- Health Economics
Background:
- The optimal initial treatment for cardiac resynchronization therapy (CRT) in heart failure (HF) patients with left bundle branch block (LBBB) is debated.
- Choosing between left bundle branch area pacing (LBBaP) and biventricular pacing (BVP) remains a clinical challenge.
Purpose of the Study:
- To compare the cost-effectiveness ratio (CER) of LBBaP versus BVP.
- To evaluate echocardiographic and clinical outcomes in HF patients with LBBB undergoing LBBaP or BVP.
Main Methods:
- Observational study including 130 HF patients with LBBB.
- Primary outcomes: echocardiographic response, LVEF improvement, hospitalization costs, and CER.
- Secondary outcomes: NYHA class, NT-proBNP levels, pacemaker parameters, complications, and mortality.
Main Results:
- LBBaP group showed significantly greater LVEF increase (20.2% vs. 10.5%) and higher echocardiographic response rates (86.1% vs. 57.8%) compared to BVP.
- Hospitalization costs were substantially lower for LBBaP ($9707.7) versus BVP ($20,046.1).
- LBBaP demonstrated a more favorable CER (112.7) than BVP (346.8).
Conclusions:
- LBBaP-CRT is a more cost-effective strategy than BVP for HF patients with LBBB.
- LBBaP offers superior cardiac function improvement and economic benefits.
- Large randomized trials are recommended to validate these findings.
Background:
For the initial treatment strategy for patients with cardiac resynchronization therapy (CRT) indications, whether to choose left bundle branch area pacing (LBBaP) or biventricular pacing (BVP) remains controversial. We aimed to investigate the cost-effectiveness ratio (CER) of LBBaP and BVP in heart failure (HF) patients with left bundle branch block (LBBB).
Methods:
This observational study included HF patients with LBBB who underwent successful LBBaP or BVP. The primary outcomes were echocardiographic response (left ventricular ejection fraction [LVEF] increase ≥5%), LVEF improvement, hospitalization costs, and CER (CER = cost/echocardiographic response rate). Secondary outcomes included other echocardiographic parameters, New York Heart Association (NYHA), N-terminal pro-B-type natriuretic peptide (NT-proBNP), pacemaker parameters, complications, ventricular arrhythmia (VA) events, HF hospitalization (HFH), and all-cause mortality.
Results:
A total of 130 patients (85 LBBaP and 45 BVP) were included (65.6 ± 10.0 years, 70.77% men). The median follow-up period was 16(12,30), months. Compared with BVP, the LBBaP group showed a greater increase in LVEF (20.2% ± 11.8% vs. 10.5% ± 13.9%; p < 0.001), higher echocardiographic response rate (86.1% vs. 57.8%; p < 0.001), and lower hospitalization costs [$9707.7 (7751.2, 18,088.5) vs. $20,046.1 (18,840.1, 22,447.3); p < 0.0001]. The CER was 112.7 and 346.8 in LBBaP and BVP, respectively. The incremental cost-effectiveness ratio (ICER = △cost/△echocardiographic response rate) was $-365.3/per 1% increase in effectiveness. LBBaP improved cardiac function more significantly than BVP. There were no significant differences in clinical outcomes.
Conclusions:
LBBaP-CRT is more cost-effective than BVP, offering greater LVEF improvement, higher echocardiographic response rates, lower hospitalization costs, and more significantly improved cardiac function. These findings need large randomized clinical trials for further confirmation.
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