title: Cost-Effectiveness of Adding Cardiac Resynchronization Therapy to an Implantable Cardioverter-Defibrillator Among Patients With Mild Heart Failure.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) reduces mortality and heart failure hospitalizations in patients with mild heart failure.
  
  
  OBJECTIVE
  To estimate the cost-effectiveness of adding CRT to an implantable cardioverter-defibrillator (CRT-D) compared with implantable cardioverter-defibrillator (ICD) alone among patients with left ventricular systolic dysfunction, prolonged intraventricular conduction, and mild heart failure.
  
  
  METHODS
  Markov decision model.
  
  
  METHODS
  Clinical trials, clinical registries, claims data from Centers for Medicare & Medicaid Services, and Centers for Disease Control and Prevention life tables.
  
  
  METHODS
  Patients aged 65 years or older with a left ventricular ejection fraction (LVEF) of 30% or less, QRS duration of 120 milliseconds or more, and New York Heart Association (NYHA) class I or II symptoms.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  CRT-D or ICD alone.
  
  
  METHODS
  Life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  Use of CRT-D increased life expectancy (9.8 years versus 8.8 years), QALYs (8.6 years versus 7.6 years), and costs ($286 500 versus $228 600), yielding a cost per QALY gained of $61 700.
  
  
  RESULTS
  The cost-effectiveness of CRT-D was most dependent on the degree of mortality reduction: When the risk ratio for death was 0.95, the ICER increased to $119 600 per QALY. More expensive CRT-D devices, shorter CRT-D battery life, and older age also made the cost-effectiveness of CRT-D less favorable.
  
  
  CONCLUSIONS
  The estimated mortality reduction for CRT-D was largely based on a single trial. Data on patients with NYHA class I symptoms were limited. The cost-effectiveness of CRT-D in patients with NYHA class I symptoms remains uncertain.
  
  
  CONCLUSIONS
  In patients with an LVEF of 30% or less, QRS duration of 120 milliseconds or more, and NYHA class II symptoms, CRT-D appears to be economically attractive relative to ICD alone when a reduction in mortality is expected.
  
  
  BACKGROUND
  National Institutes of Health, University of Copenhagen, U.S. Department of Veterans Affairs.
authors: Christopher Y
authors: CY
authors: Woo
authors: Erika J
authors: EJ
authors: Strandberg
authors: Michelle D
authors: MD
authors: Schmiegelow
authors: Allison L
authors: AL
authors: Pitt
authors: Mark A
authors: MA
authors: Hlatky
authors: Douglas K
authors: DK
authors: Owens
authors: Jeremy D
authors: JD
authors: Goldhaber-Fiebert
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000191:economics*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000191:economics*; D004562:Electrocardiography; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology