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European Heart Journal Advance Access originally published online on November 11, 2005
European Heart Journal
2005 26(24):2681-2688; doi:10.1093/eurheartj/ehi662
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Cost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial

Melanie J. Calvert1, Nick Freemantle1,*, Guiqing Yao1, John G.F. Cleland2, Lucinda Billingham1, Jean-Claude Daubert3, Stirling Bryan1 on behalf of the CARE-HF Investigators

1Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
2Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston upon Hull, UK
3Department of Cardiology, Hôpital Pontchaillou, Rennes, France

Received 21 October 2005; revised 3 November 2005; accepted 4 November 2005; online publish-ahead-of-print 11 November 2005.

* Corresponding author. Tel: +44 0121 414 7943; fax: +44 0121 414 3353. E-mail address: n.freemantle{at}bham.ac.uk

Aims Whilst the CArdiac REsynchronization in Heart Failure (CARE-HF) trial has shown that cardiac resynchronization therapy (CRT) leads to reduced morbidity and mortality, the cost-effectiveness of this therapy remains uncertain. The aim of this study was to evaluate the incremental cost per quality adjusted life year (QALY) gained and incremental cost per life year gained of CRT plus medical therapy compared to medical therapy alone.

Methods and results This prospective analysis based on intention to treat data from all patients enrolled in the CARE-HF trial at 82 clinical centres in 12 European countries. A total of 813 patients with New York Heart Association class III or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony were randomized to CRT plus medical therapy (n=409) vs. medical therapy alone (n=404). During a mean follow-up of 29.4 months CRT was associated with increased costs ({euro}4316, 95% CI: 1327–7485), survival (0.10 years, 95% CI: –0.01–0.21), and QALYs (0.22, 95% CI: 0.13–0.32). The incremental cost-effectiveness ratio was {euro}19 319 per QALY gained (95% CI: 5482–45 402) and {euro}43 596 per life-year gained (95% CI: –146 236–223 849). These results were sensitive to the costs of the device, procedure, and hospitalization.

Conclusion Treatment with CRT appears cost-effective at the notional willingness to pay threshold of {euro}29 400 (£20 000) per QALY gained.

Key Words: Cardiac resynchronization therapy • Cost-effectiveness • CARE-HF • Quality-adjusted life-year


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