title: Cost-effectiveness of cardiac resynchronization therapy: perspective from Argentina.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) has recently been shown to reduce both mid-term and long-term mortality in patients with mild heart failure. Although proven effective, it is unclear whether CRT is cost-effective in low and middle-income countries (LMIC). Therefore, we set out to analyze the cost-effectiveness of CRT in Argentina in patients with New York Heart Association (NYHA) functional class (FC) I or II heart failure (HF). We chose to compare patients receiving optimal medical treatment (OMT) and CRT with those patients receiving only OMT.
  
  
  METHODS
  We constructed a Markov model with a cohort simulation, and a life-time horizon to assess costs, life-years, and quality-adjusted life-year (QALY) gained as a result of treatment with both CRT and OMT from an Argentine third party payer perspective. We included patients who met the following criteria: left ventricular ejection fraction (LVEF) ≤ 40 percent, sinus rhythm with a QRS ≥ 120 msec, and NYHA FC I-II HF. The results were expressed as cost per life-year and QALY gained in international dollars (ID$) for the year 2009.
  
  
  RESULTS
  For the base case analysis performed, we started at a fixed age of 65. After applying a 3 percent annual discount rate, the incremental cost-effectiveness ratio (ICER) was 38.005 ID$ per year of life gained and 34.185 ID$ per QALY gained.
  
  
  CONCLUSIONS
  Long-term treatment with CRT appears to be cost-effective in Argentina compared with patients treated solely with OMT. Similar analysis should be performed to determine if this treatment option is cost-effective in other LMIC.
authors.affiliation: Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina. rpoggio@iecs.org.ar
authors.forename: Rosana
authors.initials: R
authors.lastname: Poggio
authors.forename: Federico
authors.initials: F
authors.lastname: Augustovsky
authors.forename: Joaquín
authors.initials: J
authors.lastname: Caporale
authors.forename: Vilma
authors.initials: V
authors.lastname: Irazola
authors.forename: Santiago
authors.initials: S
authors.lastname: Miriuka
mesh_terms: D000367:Age Factors; D000368:Aged; D001118:Argentina; D058406:Cardiac Resynchronization Therapy / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016019:Survival Analysis