Quadripolar left ventricular leads for cardiac resynchronization therapy reduced hospitalization rates compared to bipolar leads (42.6% vs. 55.4%; p=0.002) and were highly cost-effective.
Cohort (n=606)
Yes
Do quadripolar left ventricular leads improve cost-effectiveness compared to bipolar leads in patients receiving cardiac resynchronization defibrillator therapy?
Quadripolar LV leads for CRT-D are highly cost-effective compared to bipolar leads in the UK healthcare system, driven primarily by reduced heart failure hospitalizations and generator replacements.
Absolute Event Rate: 42.6% vs 55.4%
p-value: p=0.002
OBJECTIVES: The objective of this study was to evaluate the cost-effectiveness of quadripolar versus bipolar cardiac resynchronization defibrillator therapy systems. BACKGROUND: Quadripolar left ventricular (LV) leads for cardiac resynchronization therapy reduce phrenic nerve stimulation (PNS) and are associated with reduced mortality compared with bipolar leads. METHODS: A total of 606 patients received implants at 3 UK centers (319 Q, 287 B), between 2009 and 2014; mean follow-up was 879 days. Rehospitalization episodes were costed at National Health Service national tariff rates, and EQ-5D utility values were applied to heart failure admissions, acute coronary syndrome events, and mortality data, which were used to estimate quality-adjusted life-year differences over 5 years. RESULTS: Groups were matched with regard to age and sex. Patients with quadripolar implants had a lower rate of hospitalization than those with bipolar implants (42. 6% vs. 55. 4%; p = 0. 002). This was primarily driven by fewer hospital readmissions for heart failure (51 16% vs. 75 26. 1%, respectively, for quadripolar vs. bipolar implants; p = 0. 003) and generator replacements (9 2. 8% vs. 19 6. 6%, respectively; p = 0. 03). Hospitalization for suspected acute coronary syndrome, arrhythmia, device explantation, and lead revisions were similar. This lower health-care utilization cost translated into a cumulative 5-year cost saving for patients with quadripolar systems where the acquisition cost was <£932 (US 1, 398) compared with bipolar systems. Probabilistic sensitivity analysis results mirrored the deterministic calculations. For the average additional price of £1, 200 (US 1, 800) over a bipolar system, the incremental cost-effective ratio was £3, 692 per quality-adjusted life-year gained (US 5, 538), far below the usual willingness-to-pay threshold of £20, 000 (US 30, 000). CONCLUSIONS: In a UK health-care 5-year time horizon, the additional purchase price of quadripolar cardiac resynchronization defibrillator therapy systems is largely offset by lower subsequent event costs up to 5 years after implantation, which makes this technology highly cost-effective compared with bipolar systems.
Behar et al. (Thu,) conducted a cohort in Heart failure requiring cardiac resynchronization defibrillator therapy (n=606). Quadripolar left ventricular leads vs. Bipolar left ventricular leads was evaluated on Rate of hospitalization (p=0.002). Quadripolar left ventricular leads for cardiac resynchronization therapy reduced hospitalization rates compared to bipolar leads (42.6% vs. 55.4%; p=0.002) and were highly cost-effective.