title: A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure.
abstract: OBJECTIVE
  Cardiac resynchronization therapy with a biventricular pacemaker (CRT-P) is an effective treatment for dyssynchronous heart failure (DHF). Adding an implantable cardioverter defibrillator (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, if the majority of patients do not require shock therapy, the cost-effectiveness ratio of CRT-D compared to CRT-P may be high. The objective of this study was to systematically review decision models evaluating the cost-effectiveness of CRT-D for patients with DHF, compare the structure and inputs of these models and identify the main factors influencing the ICERs for CRT-D.
  
  
  METHODS
  A comprehensive search strategy of Medline (Ovid), Embase (Ovid) and EconLit identified eight cost-effectiveness models evaluating CRT-D against optimal pharmacological therapy (OPT) and/or CRT-P.
  
  
  RESULTS
  The selected economic studies differed in terms of model structure, treatment path, time horizons, and sources of efficacy data. CRT-D was found cost-effective when compared to OPT but its cost-effectiveness became questionable when compared to CRT-P.
  
  
  CONCLUSIONS
  Cost-effectiveness of CRT-D may increase depending on improvement of all-cause mortality rates and HF mortality rates in patients who receive CRT-D, costs of the device, and battery life. In particular, future studies need to investigate longer-term mortality rates and identify CRT-P patients that will gain the most, in terms of life expectancy, from being treated with a CRT-D.
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands. florian.tomini@maastrichtuniversity.nl.|Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands. florian.tomini@maastrichtuniversity.nl.
authors.forename: F
authors.identifier: http://orcid.org/0000-0002-2991-1487
authors.initials: F
authors.lastname: Tomini
authors.affiliation: Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Prinzen
authors.affiliation: Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: A D I
authors.initials: AD
authors.lastname: van Asselt
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics*; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D006801:Humans; D008297:Male; D008390:Markov Chains; D015201:Meta-Analysis as Topic; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Cardiac pacing; Cardiac resynchronization therapy; Cost-effectiveness; Economic; Heart failure; Implantable cardioverter-defibrillator; Markov chains; Models; Review; Sudden cardiac death