Key result
Adding cardiac resynchronization therapy to optimal medical therapy was cost-effective at 10 years, resulting in €18,431 per life-year gained and €21,500 per quality-adjusted life-year gained.
Why the study?
Does cardiac resynchronization therapy added to optimal medical therapy improve cost-effectiveness in patients with mild symptomatic or asymptomatic left ventricular dysfunction and cardiac dyssynchrony?
Does cardiac resynchronization therapy added to optimal medical therapy improve cost-effectiveness in patients with mild symptomatic or asymptomatic left ventricular dysfunction and cardiac dyssynchrony?
Answers are grounded in this paper and cite their sources.
Cardiac resynchronization therapy added to optimal medical therapy is a cost-effective strategy over a 10-year horizon for patients with mild or asymptomatic heart failure and cardiac dyssynchrony in Spain.
OBJECTIVES: The aim of the study was to combine clinical results from the European Cohort of the REVERSE study and costs associated with the addition of cardiac resynchronization therapy (CRT) to optimal medical therapy (OMT) in patients with mild symptomatic (NYHA I-II) or asymptomatic left ventricular dysfunction and markers of cardiac dyssynchrony in Spain. METHODS: A Markov model was developed with CRT + OMT (CRT-ON) versus OMT only (CRT-OFF) based on a retrospective cost-effectiveness analysis. Raw data was derived from literature and expert opinion, reflecting clinical and economic consequences of patient's management in Spain. Time horizon was 10 years. Both costs (euro 2010) and effects were discounted at 3 percent per annum. RESULTS: CRT-ON showed higher total costs than CRT-OFF; however, CRT reduced the length of hospitalization in ICU by 94 percent (0.006 versus 0.091 days) and general ward in by 34 percent (0.705 versus 1.076 days). Surviving CRT-ON patients (88.2 percent versus 77.5 percent) remained in better functional class longer, and they achieved an improvement of 0.9 life years (LYGs) and 0.77 years quality-adjusted life years (QALYs). CRT-ON proved to be cost-effective after 6 years, except for the 7th year due to battery depletion. At 10 years, the results were €18,431 per LYG and €21,500 per QALY gained. Probabilistic sensitivity analysis showed CRT-ON was cost-effective in 75.4 percent of the cases at 10 years. CONCLUSIONS: The use of CRT added to OMT represents an efficient use of resources in patients suffering from heart failure in NYHA functional classes I and II.
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Almenar‐Bonet et al. (2013) studied Mild symptomatic (NYHA I-II) or asymptomatic left ventricular dysfunction and markers of cardiac dyssynchrony. Cardiac resynchronization therapy (CRT) + optimal medical therapy (OMT) vs. Optimal medical therapy (OMT) only was evaluated on Cost-effectiveness (ICER) at 10 years (€21,500 per QALY gained). Adding cardiac resynchronization therapy to optimal medical therapy was cost-effective at 10 years, resulting in €18,431 per life-year gained and €21,500 per quality-adjusted life-year gained.
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