Cost-effectiveness of implantable cardiac devices in patients with systolic heart failure

Abstract

ObjectiveTo evaluate the cost-effectiveness of implantable cardioverter defibrillators (ICDs), cardiac resynchronisation therapy pacemakers (CRT-Ps) and combination therapy (CRT-D) in patients with heart failure with reduced ejection fraction based on a range of clinical characteristics.MethodsIndividual patient data from 13 randomised trials were used to inform a decision analytical model. A series of regression equations were used to predict baseline all-cause mortality, hospitalisation rates and health-related quality of life and device-related treatment effects. Clinical variables used in these equations were age, QRS duration, New York Heart Association (NYHA) class, ischaemic aetiology and left bundle branch block (LBBB). A UK National Health Service perspective and a lifetime time horizon were used. Benefits were expressed as quality-adjusted life-years (QALYs). Results were reported for 24 subgroups based on LBBB status, QRS duration and NYHA class.ResultsAt a threshold of £30 000 per QALY gained, CRT-D was cost-effective in 10 of the 24 subgroups including all LBBB morphology patients with NYHA I/II/III. ICD is cost-effective for all non-NYHA IV patients with QRS duration <120 ms and for NYHA I/II non-LBBB morphology patients with QRS duration between 120 ms and 149 ms. CRT-P was also cost-effective in all NYHA III/IV patients with QRS duration >120 ms. Device therapy is cost-effective in most patient groups with LBBB at a threshold of £20 000 per QALY gained. Results were robust to altering key model parameters.ConclusionsAt a threshold of £30 000 per QALY gained, CRT-D is cost-effective in a far wider group than previously recommended in the UK. In some subgroups ICD and CRT-P remain the cost-effective choice.

European Society of Cardiology: Cardiovascular Disease Statistics 2019

“…1,44 Procedure and device costs are considerable and challenge the delivery of guideline-recommended cardiovascular care in many middle-income and developing countries. 38,45 This is reflected in substantial inequalities in the resources available for invasive management of cardiovascular disease that the Atlas data highlight in documenting national interventional facilities and cardiovascular procedure rates. In this review, we examine these data and the inequalities between different ESC member countries as they associate with national prosperity and impact on the delivery of healthcare.…”

Cost-Effectiveness of an Antibacterial Envelope for Cardiac Implantable Electronic Device Infection Prevention in the US Healthcare System From the WRAP-IT Trial

“…4 , 6 Long-term life expectancy and utilities (single cardinal values between 0 and 1 reflecting the health-related quality of life of an individual at a point in time) 13 were derived from prior cost-effectiveness modeling. 14 Hospital costs were used as a surrogate for integrated payer-provider entity costs. Expected lifetime costs for device follow-up, replacement, and healthcare utilization were derived from prior estimates.…”

“…Expected lifetime costs for device follow-up, replacement, and healthcare utilization were derived from prior estimates. 14 – 16 Model input values for the base case (the primary analysis) and SEs are included in Table 1 , and more detail behind the model inputs are included in the Data Supplement (Tables I through IV in the Data Supplement ).…”

Cardiac Resynchronisation Therapy in Patients with Moderate to Severe Heart Failure in Germany: A Cost-Utility Analysis of the Additional Defibrillator

“…Therefore, the median device longevity was taken from a National Institute for Health and Care Excellence (NICE) report calculated from approximately 40,000 implementations from 2000 to 2011 [33]. Lower and higher device longevity estimates were taken from cost-effectiveness studies for the sensitivity analysis [30][31][32] (see Table 2). In the case of battery depletion the whole CRT system has to be replaced.…”

“…Other influential parameters were the device cost of a CRT-D, the device longevity for CRT-D and probability of the implementation success. In DSA deterministic sensitivity analysis, PSA probabilistic sensitivity analysis, CRT cardiac resynchronisation therapy, CRT -D cardiac biventricular defibrillator, CRT -P biventricular pacemaker, NYHA New York Heart Association, OMT optimal medical therapy, SE standard error, SD standard deviation a Costs for CRT implementation and hospitalisations were varied by distribution of DRG case severities b Gompertz survival curve [31][32][33] further sensitivity analyses other HRQoL estimates did not greatly alter the model result. With regard to different time horizons, the ICER per additional QALY for 9 years was €41,020 and for 15 years €27,016.…”