Cost-effectiveness of cardiac resynchronization therapy in the MADIT-CRT trial.
BACKGROUND
The Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) trial demonstrated that cardiac resynchronization therapy (CRT) when added to the implantable cardiac defibrillator (ICD) reduces risk of heart failure or death in minimally symptomatic patients with reduced cardiac ejection fraction and wide QRS complex.


OBJECTIVE
To evaluate 4-year cost-effectiveness of CRT-ICD compared to ICD alone using MADIT-CRT data.


METHODS
Patients enrolled in the trial were randomized to implantation of either ICD or CRT-ICD in a 2:3 ratio, with up to 4-year follow-up period. Cost-effectiveness analyses were conducted, and sensitivity analyses by age, gender, and left bundle branch block (LBBB) conduction pattern were performed.


METHODS
A total of 1,271 patients with ICD or CRT-ICD (US centers only) who reported healthcare utilization and health-related quality of life data.


METHODS
We used the EQ-5D (US weights) to assess patient HRQOL and translated utilization data to costs using national Medicare reimbursement rates.


RESULTS
Average 4-year healthcare expenditures in CRT-ICD patients were higher than costs of ICD patients ($62,600 vs 57,050, P = 0.015), mainly due to the device and implant-related costs. The incremental cost-effectiveness ratio of CRT-ICD compared to ICD was $58,330/quality-adjusted life years (QALY) saved. The cost effectiveness improved with longer time horizon and for the LBBB subgroup ($7,320/QALY), with no cost-effectiveness benefit being evident in the non-LBBB group.


CONCLUSIONS
In minimally symptomatic patients with low ejection fraction and LBBB, CRT-ICD is cost effective within 4-year horizon when compared to ICD-only.
Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14620, USA. katia_noyes@urmc.rochester.edu
Katia
K
Noyes
Peter
P
Veazie
William Jackson
WJ
Hall
Hongwei
H
Zhao
April
A
Buttaccio
Kelly
K
Thevenet-Morrison
Arthur J
AJ
Moss
D058406:Cardiac Resynchronization Therapy / Q000191:economics* / Q000401:mortality*; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D015994:Incidence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology