Modelling the economic and health consequences of cardiac resynchronization therapy in the UK.
OBJECTIVE
Clinical evidence supports the use of cardiac resynchronization therapy (CRT) in advanced heart failure, but its cost-effectiveness is still unclear. This analysis assessed the economic and health consequences in the UK of implanting a CRT in patients with NYHA class III-IV heart failure.


METHODS
A discrete event simulation of heart failure was used to compare the course over 5 years of 1000 identical pairs of patients -- one receiving both CRT and optimum pharmacologic treatment (OPT), the other OPT alone. All inputs were obtained from the data collected in the CArdiac REsynchronization in Heart Failure (CARE-HF) trial and a hospital in the UK. Direct medical costs (in 2004 pound) from the perspective of the National Health Service were considered. Both costs and benefits were discounted at 3.5%. Sensitivity analyses addressed all model inputs and multivariate analyses were performed by varying key parameters simultaneously.


RESULTS
The model predicted 471 deaths and 2263 hospitalizations over 5 years with OPT alone and 348 deaths and 1764 hospitalizations with CRT, equivalent to a 26% reduction in mortality and 22% in hospitalizations, at a discounted cost of pound 11,423 per patient with CRT vs. pound 4,900 with OPT alone. CRT was predicted to increase quality-adjusted survival by 0.43 QALYs per patient, resulting in an incremental cost-effectiveness ratio of pound 15,247 per QALY gained (range: pound 12,531- pound 23,184). Sensitivity analyses revealed that this outcome was most sensitive to time horizon and cost of implantation.


CONCLUSIONS
Based on these 5-year analyses, CRT is expected to yield substantial health benefits at a reasonable cost.
Caro
J Jaime
JJ
Caro Research Institute, Concord, MA, USA.
Guo
Shien
S
Ward
Alexandra
A
Chalil
Shajil
S
Malik
Farzana
F
Leyva
Francisco
F
D002304:Cardiac Pacing, Artificial / Q000191:economics* / Q000401:mortality; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics*; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D006801:Humans; D018803:Models, Economic; D011237:Predictive Value of Tests; D006113:United Kingdom