November 11, 2005Open Access
View Full PaperCost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial
Key Result
Cardiac resynchronization therapy plus medical therapy was cost-effective, with an incremental cost-effectiveness ratio of 19,319 per QALY gained (95% CI 5482-45,402).
Study Design
Type
RCT (n=813)
Randomization
randomized
Multicenter
Yes
Structured PICO
Does cardiac resynchronization therapy (CRT) plus medical therapy improve cost-effectiveness (cost per QALY gained) compared to medical therapy alone in patients with NYHA class III/IV heart failure and cardiac dyssynchrony?
P
Population
813 patients with NYHA class III or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony, followed for a mean of 29.4 months.
I
Intervention
Cardiac resynchronization therapy (CRT) plus medical therapy
C
Comparator
Medical therapy alone
O
Outcome
Incremental cost per quality adjusted life year (QALY) gained and incremental cost per life year gained
Cardiac resynchronization therapy is a cost-effective intervention for patients with advanced heart failure and cardiac dyssynchrony at standard willingness-to-pay thresholds.
Main Result
Effect estimate: ICER 19 319 per QALY gained (95% CI 5482-45 402)
Abstract
AIMS: Whilst the CArdiac REsynchronization in Heart Failure (CARE-HF) trial has shown that cardiac resynchronization therapy (CRT) leads to reduced morbidity and mortality, the cost-effectiveness of this therapy remains uncertain. The aim of this study was to evaluate the incremental cost per quality adjusted life year (QALY) gained and incremental cost per life year gained of CRT plus medical therapy compared to medical therapy alone. METHODS AND RESULTS: This prospective analysis based on intention to treat data from all patients enrolled in the CARE-HF trial at 82 clinical centres in 12 European countries. A total of 813 patients with New York Heart Association class III or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony were randomized to CRT plus medical therapy (n = 409) vs. medical therapy alone (n = 404). During a mean follow-up of 29.4 months CRT was associated with increased costs (4316, 95% CI: 1327-7485), survival (0.10 years, 95% CI: -0.01-0.21), and QALYs (0.22, 95% CI: 0.13-0.32). The incremental cost-effectiveness ratio was 19 319 per QALY gained (95% CI: 5482-45 402) and 43 596 per life-year gained (95% CI: -146 236-223 849). These results were sensitive to the costs of the device, procedure, and hospitalization. CONCLUSION: Treatment with CRT appears cost-effective at the notional willingness to pay threshold of 29 400 (20,000 pounds sterlings) per QALY gained.