Is combined resynchronisation and implantable defibrillator therapy a cost-effective option for left ventricular dysfunction?
OBJECTIVE
To evaluate the cost-effectiveness of combined resynchronisation and implantable defibrillator therapy for left ventricular dysfunction and explore subgroups in which such devices might be most cost-effective.


METHODS
Markov model-based economic evaluation.


METHODS
UK NHS.


METHODS
A simulated mixed age cohort of NYHA class III and IV patients with left ventricular systolic dysfunction and prolonged QRS interval.


METHODS
Cost per quality adjusted life year gained over the patient lifetime.


RESULTS
The incremental cost-effectiveness of resynchronisation therapy alone compared with optimal medical therapy was pound16,735 (95% CI: pound14,630 to pound20,333) with a 91% probability of being cost-effective at a willingness to pay threshold of pound30,000. Compared with resynchronisation alone, the incremental cost-effectiveness of combined implantable defibrillator was pound40,160 (95% CI: pound26,645 to pound59,391) with only a 26% probability of cost-effectiveness at the pound30,000 threshold. In a direct comparison across three treatments (medical treatment, resynchronisation alone and combined resynchronisation with implantable defibrillator therapy) resynchronisation alone was found to be the most cost-effective option.


CONCLUSIONS
Combined resynchronisation and implantable defibrillator therapy is not cost-effective for left ventricular dysfunction. Instead resynchronisation alone remains the most cost-effective policy option in this population. Combined devices are more likely to be cost-effective in the subgroups of younger patients or those with high risk of sudden cardiac death who would qualify for resynchronisation therapy.
Bond
Mary
M
PenTAG, Peninsula Medical School, Universities of Exeter & Plymouth, United Kingdom.
Mealing
Stuart
S
Anderson
Rob
R
Dean
John
J
Stein
Ken
K
Taylor
Rod S
RS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000191:economics*; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000191:economics*; D011211:Electric Power Supplies; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D013673:Technology Assessment, Biomedical / Q000191:economics; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000628:therapy*