Cost-effectiveness of cardiac resynchronization therapy in combination with an implantable cardioverter defibrillator (CRT-D) for the treatment of chronic heart failure from a German health care system perspective.
OBJECTIVE
The aim of the study was to assess the incremental cost-effectiveness ratio (ICER) of Cardiac Resynchronization Therapy in combination with an Implantable Cardioverter Defibrillator (CRT-D) plus Optimal Pharmacological Therapy (OPT) compared to OPT alone in patients with chronic heart failure.


RESULTS
A decision analytic model was used to estimate the ICER from a German Health Care System perspective. Effectiveness data were used as reported in the COMPANION study. Direct medical costs were considered for inpatient and outpatient treatments. Resource utilization was valued by the prices charged in 2005. Costs and effects were discounted by a discount rate of 3% per year. One-way and two-way sensitivity analyses were performed. The base-case analysis resulted in accumulated discounted QALYs of 0.958 for OPT, respectively 1.261 for CRT-D + OPT. Accumulated discounted costs were 4618 Euro for OPT, and 31 292 Euro for CRT-D + OPT, respectively, thus resulting in incremental costs per QALY gained of 88 143 Euro after two years. Considering a device longevity of seven years, this resulted in incremental costs per QALY of 24 650 Euro.


CONCLUSIONS
CRT-D plus OPT may be a cost-effective alternative for the treatment of patients with CHF in NYHA functional class III and IV depending on device longevity.
Aidelsburger
Pamela
P
CAREM GmbH, Mühlweg 2 c, 82054, Sauerlach, Germany. p.aidelsburger@carem.de
Grabein
Kristin
K
Klauss
Volker
V
Wasem
Jürgen
J
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000191:economics* / Q000706:statistics & numerical data; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics* / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005858:Germany; D017048:Health Care Costs; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D016019:Survival Analysis
D002316:Cardiotonic Agents