The cost-effectiveness of real-time pulmonary artery pressure monitoring in heart failure patients: a European perspective.
Heart failure (HF) treatment guided by physicians with access to real-time pressure measurement from a wireless implantable pulmonary artery pressure (PAP) sensor (CardioMEMS), has previously been shown to reduce HF-related hospital admissions in the CHAMPION trial. However, uncertainty remains regarding the value of CardioMEMS in European health systems where healthcare costs are significantly lower than in the USA.



A Markov model was developed to estimate the cost-effectiveness of PAP-guided treatment of HF using the CardioMEMS™ HF system compared with usual care. Cost-effectiveness was measured as the incremental cost per quality-adjusted life year (QALY) gained. In the base case analysis over a time horizon of 10 years, PAP-guided HF therapy increased cost compared with usual care by £10 916 (€14 030). QALYs per patient for usual care and PAP-guided patients were 2.57 and 3.14, respectively, reflecting an increase of 0.57 QALYs with PAP-guided treatment. The resultant incremental cost-effectiveness ratio (ICER) is £19 274 (€24 772) per QALY gained. The base case analysis did not include staff time, due to a lack of data concerning this variable. Running the model with estimated staff time included resulted in an increased ICER of between £22 342 and £25 464 per QALY gained (€28 709-32 721).



The analysis indicates that integrating wireless PAP monitoring into the management of UK HF patients is likely to be a cost-effective addition to the HF treatment pathway for appropriate patients.
National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK.
Martin R
MR
Cowie
SJM International, Inc., Zaventem, Belgium.
Marcus
M
Simon
Division of Cardiology, University of California San Francisco, San Francisco, CA, USA.
Liviu
L
Klein
Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Sheffield, UK.
Praveen
P
Thokala
D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination / Q000191:economics*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics* / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D018803:Models, Economic; D011669:Pulmonary Wedge Pressure
Cost-effectiveness; Heart failure; Pulmonary artery pressure monitoring; Telemonitoring