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Long-term treatment with cardiac resynchronization therapy (CRT-P) for patients with heart failure (HF) and cardiac dyssynchrony appears cost-effective compared with medical therapy alone, researchers say.
Furthermore, their study suggests that addition of an implantable cardioverter defibrillator (ICD) to CRT-P (CRT-ICD) may also be cost-effective when compared with CRT-P plus MT, from a lifetime perspective.
Nick Freemantle (University of Birmingham, UK) and colleagues compared the cost-effectiveness of CRT-P with MT alone, and that of CRT-ICD plus MT with CRT-P plus MT using data from the Cardiac Resynchronization in Heart Failure (CARE-HF) and the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trials.
The team constructed a Markov model with Monte Carlo simulation, which consists of a short-term component representing changes in health status and the costs and consequences of the process of device implantation, and a long-term component accounting for effects of the device after successful implantation.
New York Heart Association class distribution and transitions, associated health utilities, rates, and causes of hospitalization and death were estimated from CARE-HF, while the estimated additional benefit of an ICD on survival was based on COMPANION.
From a lifetime perspective, the incremental cost-effectiveness of CRT-P compared with MT in a 65-year-old patient is €7538 (US $9528) per quality adjusted life year (QALY) gained and €7011 (US $9,075) per life year gained, the authors report.
Meanwhile the incremental cost-effectiveness of CRT-ICD compared with CRT-P is €47,909 (US $62,067) per QALY gained ad €35,864 (US $46,456) per life year.
However, the authors note that the latter "may not be considered an appropriate comparison as the treatment with high cost relative to benefits may appear cost effective when combined with a highly cost-effective regimen."
"CRT-P appears a highly cost-effective addition to MT among eligible patients," the authors write in the European Heart Journal.
