Key result
Cardiac resynchronization therapy combined with optimal medical therapy proved to be highly cost-effective across multiple healthcare settings, with ICERs ranging from €3,048 to €71,447 per QALY gained.
Why the study?
CRT reduces symptoms, hospitalizations, and mortality in heart failure but increases healthcare costs, requiring evaluation of its cost-effectiveness compared with standard optimal medical therapy.
Does cardiac resynchronization therapy (CRT) improve cost-effectiveness (QALYs and ICERs) in adult patients with symptomatic heart failure and reduced ejection fraction?
Systematic Review (n=18)
Does cardiac resynchronization therapy (CRT) improve cost-effectiveness (QALYs and ICERs) in adult patients with symptomatic heart failure and reduced ejection fraction?
CRT-P combined with optimal medical therapy is a highly cost-effective treatment for symptomatic HFrEF across diverse healthcare settings, whereas CRT-D has variable cost-effectiveness and should be reserved for high-risk patients.
Answers are grounded in this paper and cite their sources.
Supports CRT-P adoption in symptomatic HFrEF; reinforces cost-effectiveness evidence across settings.
Background and aim Heart failure (HF) remains a global public health challenge, with high morbidity, mortality, and healthcare costs despite advances in pharmacological and interventional therapies. Cardiac resynchronization therapy (CRT) reduces symptoms, hospitalizations, and mortality, but is associated with increased healthcare costs. This review aims to evaluate the existing evidence on the cost-effectiveness of CRT compared with standard optimal medical therapy. Methods A systematic search of Web of Science, PubMed, and Scopus was conducted from January 2004 up to July 2025 to identify studies reporting economic outcomes such as quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) for CRT treatment in addition to optimal medical therapy (OMT) compared to OMT only. The study was registered in PROSPERO. We included studies comparing CRT plus OMT with OMT alone, as well as CRT-P vs. CRT-D. Costs were converted to 2024 euros (€) and assessed against country-specific willingness-to-pay thresholds. Results Eighteen studies met the inclusion criteria and were included in the final review CRT + OMT proved to be highly cost-effective across multiple healthcare settings: ICERs ranged from €3,048-€71,447/QALY gained. CRT-D compared with CRT-P showed more cost variability, with ICERs varying between €24,909-€105,572/QALY gained, often exceeding accepted country-specific willingness-to-pay thresholds. Conclusions This review confirms that CRT, particularly CRT-P, is a cost-effective treatment for patients with HFrEF who remain symptomatic despite OMT. CRT-D had variable cost-effectiveness, thus should be reserved for selected high-risk patients. These findings support prioritizing CRT-P as a high-value therapy within advanced heart failure care. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251171292 , PROSPERO CRD420251171292.
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Bajraktari et al. (2026) conducted a systematic review in Heart failure with reduced ejection fraction (HFrEF) (n=18). Cardiac resynchronization therapy (CRT) plus optimal medical therapy (OMT) vs. Optimal medical therapy (OMT) alone was evaluated on Incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained (ICER €3,048-€71,447/QALY). Cardiac resynchronization therapy combined with optimal medical therapy proved to be highly cost-effective across multiple healthcare settings, with ICERs ranging from €3,048 to €71,447 per QALY gained.
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