Economic assessment of cardiac resynchronization therapy.
OBJECTIVE
Cardiac resynchronization devices have been shown to be effective in treating heart failure. They reduce overall mortality, heart failure mortality and hospitalizations due to heart failure. The aim of this study was to compare the cost-effectiveness of cardiac resynchronization therapy (CRT) with that of optimal drug therapy (ODT) by carrying out an economic assessment in the Spanish healthcare setting.


METHODS
An existing model was adapted for use in the Spanish healthcare setting. The effectiveness of cardiac resynchronization therapy was determined from published systematic reviews. The costs of the various interventions were determined using a range of Spanish data sources. The model adopted the perspective of the public health system and the time horizon considered was the remainder of the patient's life. The outcome variables were life-years gained and quality-adjusted life-years (QALYs) gained.


RESULTS
Overall, ODT, CRT and CRT with a defibrillator resulted in gains of 2.11, 2.8 and 3.19 QALYs, respectively, at a cost of €11,722, €31,629 and €52,592, respectively. Consequently, each QALY gained with CRT relative to ODT involved the consumption of €28,612 of additional resources. Similarly, the use of CRT with a defibrillator cost an additional €53,547 per QALY relative to CRT without a defibrillator.


CONCLUSIONS
The use of CRT without a defibrillator could be a cost-effective alternative to ODT for treating heart failure in a carefully selected group of patients. The study results were sensitive to uncertainties in many of the variables used in the model.
Unidad de Evaluación de Tecnologías Sanitarias (UETS), Agencia Laín Entralgo, Comunidad de Madrid, Madrid, España. daniel.callejo@salud.madrid.org
Daniel
D
Callejo
Mercedes
M
Guerra
Antonio
A
Hernández-Madrid
Juan A
JA
Blasco
D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D006801:Humans; D008297:Male