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
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator
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 
7538 (95% CI 5325–11 784) per QALY gained and 7011 (95% CI 5346–10 003) per life year gained. The incremental cost-effectiveness of CRT–ICD compared with CRT-P is 47 909 (95% CI 35 703–79 438) per QALY gained, and 35 864 (95% CI 26 709–56 353) 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
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. Boriani, M. Biffi, C. Martignani, C. Valzania, I. Diemberger, M. Bertini, G. Domenichini, M. Ziacchi, and A. Branzi Is cardiac resynchronization therapy cost-effective? Europace, November 1, 2009; 11(suppl_5): v93 - v97. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Daubert, C. Leclercq, and P. Mabo Cardiac resynchronization therapy in combination with implantable cardioverter-defibrillator Europace, November 1, 2009; 11(suppl_5): v87 - v92. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M Cubbon and K. K A Witte Cardiac resynchronisation therapy for chronic heart failure and conduction delay BMJ, April 28, 2009; 338(apr28_2): b1265 - b1265. [Full Text]
|
|
|
|
 |
|
 D.T. Connelly Current controversies in using electrical devices Eur J Heart Fail Suppl, April 1, 2009; 8(suppl_1): i21 - i24. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Setoguchi, A. Nohria, J. A. Rassen, L. W. Stevenson, and S. Schneeweiss Maximum potential benefit of implantable defibrillators in preventing sudden death after hospital admission because of heart failure Can. Med. Assoc. J., March 17, 2009; 180(6): 611 - 616. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W.X. Foley, S. Chalil, K. Khadjooi, R. E.A. Smith, M. P. Frenneaux, and F. Leyva Long-term effects of cardiac resynchronization therapy in octogenarians: a comparative study with a younger population Europace, November 1, 2008; 10(11): 1302 - 1307. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Blomstrom, M. Ekman, C. B. Lundqvist, M.J. Calvert, N. Freemantle, S. Lonnerholm, G. Wikstrom, and B; Jonsson Cost effectiveness of cardiac resynchronization therapy in the Nordic region: An analysis based on the CARE-HF trial Eur J Heart Fail, September 1, 2008; 10(9): 869 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Ding, W. Hua, H. Niu, K. Chen, and S. Zhang Primary prevention of sudden cardiac death using implantable cardioverter defibrillators Europace, September 1, 2008; 10(9): 1034 - 1041. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G F Cleland, A. Tageldien, N. Maarouf, and N. Hobson Patients with heart failure who require an implantable defibrillator should have cardiac resynchronisation routinely Heart, August 1, 2008; 94(8): 963 - 966. [Full Text] [PDF]
|
|
|
|
|
|
J. G.F. Cleland, A. P. Coletta, A. Yassin, H. Hado, D. Cullington, A. T. Abdellah, and A. L. Clark Clinical trials update from the American College of Cardiology 2008: Carisma, Trends, meta-analysis of Cox-2 studies, Hat, on-Target, Hyvet, Accomplish, Momentum, Protect, Horizon-hf and Reverse Eur J Heart Fail, June 1, 2008; 10(6): 614 - 620. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
M. Metra, P. Ponikowski, K. Dickstein, J. J.V. McMurray, A. Gavazzi, C.-H. Bergh, A. G. Fraser, T. Jaarsma, A. Pitsis, P. Mohacsi, et al. Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology Eur J Heart Fail, June 1, 2007; 9(6-7): 684 - 694. [Abstract] [Full Text] [PDF]
|
|