Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure.
BACKGROUND
Heart failure is a common, costly, and debilitating illness. Resynchronization of ventricular contraction in patients with heart failure improves ejection fraction. The long-term morbidity and costs associated with such cardiac resynchronization therapy remain unclear.


OBJECTIVE
To assess the incremental cost-effectiveness of cardiac resynchronization therapy.


METHODS
Markov model with Monte Carlo simulation. Future costs and effects were discounted at 3%.


METHODS
Effects data were obtained from a concurrent systematic review. Health-related quality-of-life and cost data were obtained from publicly available data or from surveys.


METHODS
Patients with reduced ventricular function and prolonged QRS.


METHODS
Lifetime.


CONCLUSIONS
U.S. health care system.


METHODS
Cardiac resynchronization therapy versus medical therapy.


METHODS
Quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness.


RESULTS
Medical therapy yielded a median of 2.64 (interquartile range, 2.47 to 2.82) discounted QALYs and a median discounted lifetime cost of 34,400 dollars (interquartile range, 31,100 dollars to 37,700 dollars). Cardiac resynchronization therapy was associated with a median incremental cost of 107,800 dollars(interquartile range, 79,800 dollars to 156,500 dollars) per additional QALY.


RESULTS
Results were sensitive to changes in several variables, including the relative risk for death or hospitalization.


CONCLUSIONS
These results apply to patients who meet the inclusion criteria of the currently completed trials.


CONCLUSIONS
The incremental cost per QALY for cardiac resynchronization is similar to that of other commonly used interventions but is sensitive to changes in several key variables. Resynchronization therapy should not be considered in patients with comorbid illness that shortens life expectancy.
Nichol
Graham
G
University of Washington-Harborview Prehospital Emergency Care Research and Training Center and Harborview Medical Center, Seattle, Washington 98104, USA. nichol@u.washington.edu
Kaul
Padma
P
Huszti
Ella
E
Bridges
John F P
JF
D002304:Cardiac Pacing, Artificial / Q000191:economics*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017147:Defibrillators, Implantable / Q000191:economics; D004554:Electric Countershock / Q000191:economics*; D006333:Heart Failure / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008390:Markov Chains; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years