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European Heart Journal Advance Access originally published online on February 23, 2006
European Heart Journal 2006 27(9):1125; doi:10.1093/eurheartj/ehi801
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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

Andrew Owen

Department of Cardiology
Kent and Canterbury Hospital
Ethelbert Road
Canterbury
Kent CT1 3NG
UK

The report by Calvert et al.1 on the cost-effectiveness of cardiac resynchronization therapy from the CARE-HF trial relies on the prediction of patient survival beyond the end of the trial. The authors found this to be necessary so that the expected 6-year life of the device could be used to distribute the cost more evenly. This presents a number of difficulties as we have no way of knowing how accurate such a prediction is. The authors assessed a number of parametric survival models, including the exponential and the Weibull. The Akaike information criteria (AIC) were used to choose the most appropriate model. This leads to the adoption of an exponential model. The AIC, however, is a measure of how well the model fits the data; it is not a measure of how well the model is able to predict future survival. The exponential model has a constant hazard function which for the cohort of relatively older patients in the trial is unlikely to be realistic.2 It would be helpful if the authors could give some indication as to what effect the choice of model has on the results presented. It is not clear that the exponential model is superior to the Weibull in this setting.

References

  1. Calvert MJ, Freemantle N, Yao G, Cleland JGF, Billingham L, Daubert J-C, Bryan S. Cost effectiveness of cardiac resynchronisation therapy: results from the CARE-HF trial. Eur Heart J 2005: 26; 2681–2688.[Abstract/Free Full Text]
  2. Woodward M, Epidemiology Study Design and Data Analysis. Florida: Chapman and Hall; 1999.

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This Article
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