Is cardiac resynchronization therapy cost-effective?
Cardiac resynchronization therapy (CRT) is a treatment of proven efficacy for selected patients with heart failure and associated conduction disturbances. The increasing financial burden that healthcare systems face has increased the interest in cost-effectiveness and cost-utility estimates, focused on devices with defibrillation capabilities (CRT-D), with a high upfront cost, as well as on simpler devices providing only biventricular pacing (CRT-P). Available economic estimates are largely dependent on data source, assumptions, modelling technique, time horizon, and perspective, leading to some variability in cost-effectiveness and cost-utility estimates. As a whole, cost-effectiveness and cost-utility estimates of both CRT-P and CRT-D improve as the time horizon examined is lengthened and appear to be below US$50,000 per quality-adjusted life-year, a threshold value commonly adopted for coverage of healthcare interventions in the USA and quite comparable with similar thresholds used within Europe. Limited data are available on the comparative cost-effectiveness or cost-utility of CRT-P and CRT-D devices. Moreover, more data on the effectiveness and long-term benefits of CRT-D and CRT-P are needed in order to estimate better the value of these treatments in the 'real world, as well as for attempts to improve cost-effectiveness through improved patient selection.
Institute of Cardiology, University of Bologna and Azienda Ospedaliera S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. giuseppe.boriani@unibo.it
Giuseppe
G
Boriani
Mauro
M
Biffi
Cristian
C
Martignani
Cinzia
C
Valzania
Igor
I
Diemberger
Matteo
M
Bertini
Giulia
G
Domenichini
Matteo
M
Ziacchi
Angelo
A
Branzi
D003362:Cost-Benefit Analysis; D047548:Defibrillators / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics; D005060:Europe; D006333:Heart Failure / Q000191:economics* / Q000628:therapy*; D006801:Humans; D010138:Pacemaker, Artificial / Q000191:economics*; D018579:Patient Selection; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014481:United States