title: Cost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  Treatment with CRT appears cost-effective at the notional willingness to pay threshold of 29 400 (20,000 pounds sterlings) per QALY gained.
authors.affiliation: Department of Primary Care and General Practice, University of Birmingham, Edgbaston, UK.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Calvert
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.forename: Guiqing
authors.initials: G
authors.lastname: Yao
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Lucinda
authors.initials: L
authors.lastname: Billingham
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Daubert
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000191:economics*; D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000191:economics*; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000191:economics / Q000628:therapy*