title: Cost-effectiveness of implantable cardiac devices in patients with systolic heart failure.
abstract: To evaluate the cost-effectiveness of implantable cardioverter defibrillators (ICDs), cardiac resynchronisation therapy pacemakers (CRT-Ps) and combination therapy (CRT-D) in patients with heart failure with reduced ejection fraction based on a range of clinical characteristics.
  
  
  
  Individual patient data from 13 randomised trials were used to inform a decision analytical model. A series of regression equations were used to predict baseline all-cause mortality, hospitalisation rates and health-related quality of life and device-related treatment effects. Clinical variables used in these equations were age, QRS duration, New York Heart Association (NYHA) class, ischaemic aetiology and left bundle branch block (LBBB). A UK National Health Service perspective and a lifetime time horizon were used. Benefits were expressed as quality-adjusted life-years (QALYs). Results were reported for 24 subgroups based on LBBB status, QRS duration and NYHA class.
  
  
  
  At a threshold of £30 000 per QALY gained, CRT-D was cost-effective in 10 of the 24 subgroups including all LBBB morphology patients with NYHA I/II/III. ICD is cost-effective for all non-NYHA IV patients with QRS duration <120 ms and for NYHA I/II non-LBBB morphology patients with QRS duration between 120 ms and 149 ms. CRT-P was also cost-effective in all NYHA III/IV patients with QRS duration >120 ms. Device therapy is cost-effective in most patient groups with LBBB at a threshold of £20 000 per QALY gained. Results were robust to altering key model parameters.
  
  
  
  At a threshold of £30 000 per QALY gained, CRT-D is cost-effective in a far wider group than previously recommended in the UK. In some subgroups ICD and CRT-P remain the cost-effective choice.
authors.affiliation: ICON Health Economics, ICON Clinical Research (UK) Ltd., Abingdon, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Mealing
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Woods
authors.affiliation: ICON Health Economics, ICON Clinical Research (UK) Ltd., Abingdon, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Hawkins
authors.affiliation: National Heart & Lung Institute, Imperial College London (Royal Brompton Hospital), London, UK.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
authors.affiliation: Cardiothoracic Directorate, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Plummer
authors.affiliation: Department of Internal Medicine, Ohio State University Medical Centre, Columbus, Ohio, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.affiliation: Department of Cardiovascular Diseases Mayo Clinic, Phoenix, Arizona, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Beshai
authors.affiliation: University of Rochester Medical Centre, University of Rochester, New York, USA.
authors.forename: Helmut
authors.initials: H
authors.lastname: Klein
authors.affiliation: ICON Health Economics, ICON Clinical Research (UK) Ltd., Abingdon, UK Centre for Health Economics, University of York, York, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Sculpher
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017147:Defibrillators, Implantable / Q000191:economics*; D004554:Electric Countershock / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D018803:Models, Economic; D018579:Patient Selection; D017064:Process Assessment, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome