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European Heart Journal Advance Access published online on November 11, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi662
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received October 21, 2005
Revised November 3, 2005
Accepted November 4, 2005

Clinical research

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

Melanie J. Calvert 1, Nick Freemantle 1*, Guiqing Yao 1, John G.F. Cleland 2, Lucinda Billingham 1, Jean-Claude Daubert 3, Stirling Bryan 1, and on behalf of the CARE-HF Investigators

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

* To whom correspondence should be addressed.
Nick Freemantle, E-mail: n.freemantle{at}bham.ac.uk


  Abstract

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.

Keywords: Cardiac resynchronization therapy; Cost-effectiveness; CARE-HF; Quality-adjusted life-year.
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