title: Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial.
abstract: OBJECTIVE
  The analysis goal was to estimate incremental cost-effectiveness ratios (ICERs) for the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial patients who received cardiac resynchronization therapy (CRT) via pacemaker (CRT-P) or pacemaker-defibrillator (CRT-D) in combination with optimal pharmacological therapy (OPT) relative to patients with OPT alone.
  
  
  BACKGROUND
  In the COMPANION trial, CRT-P and CRT-D reduced the combined risk of all-cause mortality or first hospitalization among patients with advanced heart failure and intraventricular conduction delays, but the cost effectiveness of the therapy remains unknown.
  
  
  METHODS
  In this analysis, intent-to-treat trial data were modeled to estimate the cost effectiveness of CRT-D and CRT-P relative to OPT over a base-case seven-year treatment episode. Exponential survival curves were derived from trial data and adjusted by quality-of-life trial results to yield quality-adjusted life-years (QALYs). For the first two years, follow-up hospitalizations were based on trial data. The model assumed equalized hospitalization rates beyond two years. Initial implantation and follow-up hospitalization costs were estimated using Medicare data.
  
  
  RESULTS
  Over two years, follow-up hospitalization costs were reduced by 29% for CRT-D and 37% for CRT-P. Extending the cost-effectiveness analysis to a seven-year base-case time period, the ICER for CRT-P was 19,600 dollars per QALY and the ICER for CRT-D was 43,000 dollars per QALY relative to OPT.
  
  
  CONCLUSIONS
  For the COMPANION trial patients, the use of CRT-P and CRT-D was associated with a cost-effectiveness ratio below generally accepted benchmarks for therapeutic interventions of 50,000 dollars per QALY to 100,000 dollars per QALY. This suggests that the clinical benefits of CRT-P and CRT-D can be achieved at a reasonable cost.
authors.affiliation: Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. arthur.feldman@jefferson.edu
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Feldman
authors.forename: Gregory
authors.initials: G
authors.lastname: de Lissovoy
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bristow
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Saxon
authors.forename: Teresa
authors.initials: T
authors.lastname: De Marco
authors.forename: David A
authors.initials: DA
authors.lastname: Kass
authors.forename: John
authors.initials: J
authors.lastname: Boehmer
authors.forename: Steven
authors.initials: S
authors.lastname: Singh
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.forename: Peter
authors.initials: P
authors.lastname: Carson
authors.forename: Audra
authors.initials: A
authors.lastname: Boscoe
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Baker
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Gunderman
mesh_terms: D002303:Cardiac Output, Low / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000191:economics*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004554:Electric Countershock / Q000191:economics*; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D002316:Cardiotonic Agents