Skip Navigation


European Heart Journal Advance Access originally published online on November 16, 2006
European Heart Journal 2007 28(1):42-51; doi:10.1093/eurheartj/ehl382
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
28/1/42    most recent
ehl382v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (12)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Yao, G.
Right arrow Articles by Cleland, J. G.F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yao, G.
Right arrow Articles by Cleland, J. G.F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator

Guiqing Yao1, Nick Freemantle1,*, Melanie J. Calvert1, Stirling Bryan2, Jean-Claude Daubert3 and John G.F. Cleland4

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

Received 21 June 2006; revised 26 September 2006; accepted 26 October 2006; online publish-ahead-of-print 16 November 2006.

* Corresponding author. Tel: +44 121 414 7943; fax: +44 121 414 3353. E-mail address: n.freemantle{at}bham.ac.uk

Aims Cardiac resynchronization therapy (CRT-P) is an effective treatment for patients with heart failure and cardiac dyssynchrony with moderate or severe symptoms despite pharmacological therapy. The addition of an implantable cardioverter-defibrillator (ICD) function may further reduce the risk of sudden death. We assessed the cost-effectiveness of CRT-P compared with medical therapy (MT) alone, and the cost-effectiveness of CRT–ICD + MT compared with CRT-P + MT, on incremental cost per quality adjusted life year (QALY) and life year using data from two landmark clinical trials.

Methods and results A Markov model with Monte Carlo simulation to assess costs, life years, and QALYs associated with CRT (± ICD) and MT in patients with heart failure and cardiac dyssynchrony, on the basis of a UK healthcare perspective was constructed. NYHA class distribution and transitions, associated health utilities, rates and cause of hospitalization and death were estimated from individual patient data from the CArdiac REsychronization in Heart Failure (CARE-HF trial). The estimated additional benefit on survival of an ICD was based on results from COMPANION. The base case analysis used 10 000 individual life-time simulations assuming a battery life of 6 years for CRT-P and 7 years for CRT–ICD. From a life-time perspective in a 65-year-old patient, the incremental cost-effectiveness of CRT-P compared with MT is {euro}7538 (95% CI {euro}5325–{euro}11 784) per QALY gained and {euro}7011 (95% CI {euro}5346–{euro}10 003) per life year gained. The incremental cost-effectiveness of CRT–ICD compared with CRT-P is {euro}47 909 (95% CI {euro}35 703–{euro}79 438) per QALY gained, and {euro}35 864 (95% CI {euro}26 709–{euro}56 353) per life year gained.

Conclusion Long-term treatment with CRT-P appears cost-effective compared with MT alone. From a life-time perspective, assuming a reasonable life expectancy when receiving effective treatment for heart failure, CRT–ICD may also be considered cost-effective when compared with CRT-P + MT.

Key Words: Cost effectiveness • Cardiac resynchronization therapy • Implantable cardioverter defibrillator • Markov model • Individual simulation


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 EuropaceHome page
L. Ding, W. Hua, H. Niu, K. Chen, and S. Zhang
Primary prevention of sudden cardiac death using implantable cardioverter defibrillators
Europace, June 16, 2008; (2008) eun150v1.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
J. B. Johansen, S. S. Pedersen, H. Spindler, K. Andersen, J. C. Nielsen, and P. T. Mortensen
Symptomatic heart failure is the most important clinical correlate of impaired quality of life, anxiety, and depression in implantable cardioverter-defibrillator patients: a single-centre, cross-sectional study in 610 patients
Europace, May 1, 2008; 10(5): 545 - 551.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
A. Torabi, J. G.F. Cleland, N. K. Khan, P. H. Loh, A. L. Clark, F. Alamgir, J. L. Caplin, A. S. Rigby, and K. Goode
The timing of development and subsequent clinical course of heart failure after a myocardial infarction
Eur. Heart J., April 1, 2008; 29(7): 859 - 870.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
H. M. Krumholz and F. A. Masoudi
The Year in Epidemiology, Health Services Research, and Outcomes Research
J. Am. Coll. Cardiol., December 4, 2007; 50(23): 2254 - 2262.
[Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
C. Leclercq, G. B. Bleeker, C. Linde, E. Donal, J. J. Bax, M. J. Schalij, and C. Daubert
Cardiac resynchronization therapy: clinical results and evolution of candidate selection
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I94 - I106.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Europace, October 1, 2007; 9(10): 959 - 998.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Eur. Heart J., September 2, 2007; 28(18): 2256 - 2295.
[Full Text] [PDF]

Home page
 HeartHome page
C Leclercq
New guidelines for cardiac resynchronisation therapy: simplicity or complexity for the doctor?
Heart, September 1, 2007; 93(9): 1017 - 1019.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
F. A. McAlister, J. Ezekowitz, N. Hooton, B. Vandermeer, C. Spooner, D. M. Dryden, R. L. Page, M. A. Hlatky, and B. H. Rowe
Cardiac Resynchronization Therapy for Patients With Left Ventricular Systolic Dysfunction: A Systematic Review
JAMA, June 13, 2007; 297(22): 2502 - 2514.
[Abstract] [Full Text] [PDF]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.