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European Heart Journal 2003 24(9):879; doi:10.1016/S0195-668X(02)00819-9
Copyright © 2003 by the European Society of Cardiology.
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Reply to letter

Cost-effectiveness of cardiac resynchronization therapy in heart failure

Massimo Santini* and Renato Ricci

Department of Cardiology, San Filippo Neri Hospital, via Martinotti, 20, 00135 Rome, Italy

* Corresponding author. Tel.: +39-06-3306-2294; fax: +39-06-3306-2489
E-mail address: m.santini{at}rmnet.it

E-mail address: rricci{at}micanet.net

Cost–benefit analysis of new therapies and economical impact of new technologies represent a major challenge for contemporary physicians and health care professionals. Theinteresting letter of Laurent Fauchier and colleagues witnesses that economical analysis is mandatory when trying to translate clinical trial results in everyday practice. This is particularly true for cardiac resynchronization therapy, which could be theoretically suggested for 15–30% of patients with heart failure. In fact, it has been hypothesized that 50,000 people in Europe may become candidates for implantation. In our opinion, Fauchier analysis on MIRACLE trial results represents a slightly provocative exercise about how to look at clinical studies. As a matter of fact, no definite data are available regarding the impact of cardiac resynchronization on survival and no cost–benefit analysis may be applied to this. Six-month results of device therapy on hospitalizations represent just a sample test and it is difficult to accept that any new therapy may be accepted if benefits longer than 6 months are not expected. Furthermore, calculation of device costs may be debatable, since either device longevity should be more than 4 years (taking into account that power source isdifferent from that used in conventional pacemaker) or the present technological development and clinical research will strongly affect device price, which will probably decrease in the near future. Finally, last but not least, there is one datum missing in the formula used by Fauchier to calculate cost-effectiveness of cardiac resynchronization therapy. The missing datum is the economical value of improved functional status and quality of life of patients with heart failure, which, by the way, represents the main aim of clinical activities.


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This Article
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