title: Modelling the economic and health consequences of cardiac resynchronization therapy in the UK.
abstract: 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.
authors.affiliation: Caro Research Institute, Concord, MA, USA.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Caro
authors.forename: Shien
authors.initials: S
authors.lastname: Guo
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ward
authors.forename: Shajil
authors.initials: S
authors.lastname: Chalil
authors.forename: Farzana
authors.initials: F
authors.lastname: Malik
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
mesh_terms: 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