Cardiac Resynchronization Therapy With Defibrillator Using the JROAD-DPC Database: Cost-Effectiveness Analysis

Area of Science:

• Cardiology
• Health Economics
• Medical Technology Assessment

Background:

• Heart failure with reduced ejection fraction (HFrEF) prevalence is rising in Japan.
• Cardiac resynchronization therapy with defibrillator (CRT-D) improves outcomes in HFrEF patients.
• The cost-effectiveness of CRT-D in Japan remains uncertain.

Purpose of the Study:

• To evaluate the cost-effectiveness of CRT-D for HFrEF patients in Japan.
• To inform healthcare policy and clinical decision-making regarding CRT-D implementation.
• To identify key factors influencing the economic value of CRT-D.

Main Methods:

• A partitioned survival model was used, incorporating 3 health states: follow-up, hospitalization, and death.
• Patient survival data were reconstructed from the RAFT trial, with optimal medical therapy (OMT) as the comparator.
• Cost and utility data were derived from Japanese databases and medical fee schedules over a 20-year horizon.

Main Results:

• CRT-D yielded an incremental cost-effectiveness ratio (ICER) of ¥5,009,880 per quality-adjusted life year (QALY).
• Sensitivity analyses indicated treatment efficacy and initial cost as primary drivers of the ICER.
• At a willingness-to-pay threshold of ¥5,000,000 per QALY, CRT-D had a 49.2% probability of being cost-effective.

Conclusions:

• CRT-D demonstrates acceptable cost-effectiveness for HFrEF patients within the Japanese healthcare system.
• Appropriate patient selection and cost-reduction strategies are crucial for maximizing the economic value of CRT-D.
• Further research may refine cost-effectiveness estimates based on long-term outcomes and evolving technology.