Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial.
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.
Feldman
Arthur M
AM
Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. arthur.feldman@jefferson.edu
de Lissovoy
Gregory
G
Bristow
Michael R
MR
Saxon
Leslie A
LA
De Marco
Teresa
T
Kass
David A
DA
Boehmer
John
J
Singh
Steven
S
Whellan
David J
DJ
Carson
Peter
P
Boscoe
Audra
A
Baker
Timothy M
TM
Gunderman
Matthew R
MR
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
D002316:Cardiotonic Agents