A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

Tomini, Florian; Prinzen, Frits W.; Asselt, Antoinette D. I. van

doi:10.1007/s10198-015-0752-3

Cited by 11 publications

(13 citation statements)

References 41 publications

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“…Our estimated ICER is lower than the ICERs reported in other studies investigating the cost-effectiveness of CRT-D to CRT-P. The range of costs per additional QALY reported in the literature is €30,447–€56,719 in 2014 prices [ 24 ]. Most of the studies are based on survival data from COMPANION or CARE-HF.…”

Section: Discussionmentioning

confidence: 54%

“…Hazard in the literature is €30,447-€56,719 in 2014 prices [24]. Most of the studies are based on survival data from COM-PANION or CARE-HF.…”

Section: Discussionmentioning

confidence: 99%

“…Input parameters for the transition probabilities and device longevity calculations are based on single RCTs used by six meta-analyses [ 11 – 13 , 22 – 24 ]. Two additional references [ 9 , 25 ] were found by literature search via PubMed.…”

Section: Methodsmentioning

confidence: 99%

“…More recent meta-analyses such as Barra et al [13] have not included other relevant RCTs. Input parameters for the transition probabilities and device longevity calculations are based on single RCTs used by six meta-analyses [11][12][13][22][23][24]. Two additional references [9,25] were found by literature search via Pub-Med.…”

Section: Model Parametersmentioning

confidence: 99%

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

Hadwiger

Frielitz

Eisemann

et al. 2020

Appl Health Econ Health Policy

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Background Cardiac resynchronisation therapy (CRT) is a well-established form of treatment for patients with heart failure and cardiac dyssynchrony. There are two different types of CRT devices: the biventricular pacemaker (CRT-P) and the biventricular defibrillator (CRT-D). The latter is more complex but also more expensive. For the majority of patients who are eligible for CRT, both devices are appropriate according to current guidelines. The purpose of this study was to conduct a cost-utility analysis for CRT-D compared to CRT-P from a German payer's perspective. Methods A cohort Markov-model was developed to assess average costs and quality-adjusted life-years (QALY) for CRT-D and CRT-P. The model consisted of six stages: one for the device implementation, one for the absorbing state death, and two stages ("Stable" and "Hospital") for either a CRT device or medical therapy. The time horizon was 20 years. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted. Results The incremental cost-effectiveness ratio (ICER) of CRT-D compared with CRT-P was €24,659 per additional QALY gained. In deterministic sensitivity analysis, the survival advantage of CRT-D to CRT-P was the most influential input parameter. In the probabilistic sensitivity analysis 96% of the simulated cases were more effective but also more costly. Conclusions Therapy with CRT-D compared to CRT-P resulted in an additional gain of QALYs, but was more expensive. In addition, the ICER was subject to uncertainty, especially due to the uncertainty in the survival benefit. A randomised controlled trial and subgroup analyses would be desirable to further inform decision making.

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Section: Discussionmentioning

confidence: 54%

“…Hazard in the literature is €30,447-€56,719 in 2014 prices [24]. Most of the studies are based on survival data from COM-PANION or CARE-HF.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Model Parametersmentioning

confidence: 99%

See 2 more Smart Citations

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

Hadwiger

Frielitz

Eisemann

et al. 2020

Appl Health Econ Health Policy

View full text Add to dashboard Cite

show abstract

“…However, the benefits to be gained from ICD use should be weighed against the risks for complications and side effects. Moreover, the differential impact of ICD on different modes of death should also be taken into account in studies evaluating ICD effectiveness . In fact, a comprehensive evaluation of all key elements in play represents the best strategy for identifying predictors of success and failure of ICD therapy.…”

Section: Fundingmentioning

confidence: 99%

Should we rethink the indications for implantable cardioverter‐defibrillators in non‐ischaemic dilated cardiomyopathy?

Curcio

Rosa

Indolfi

2017

European J of Heart Fail

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Heart failure (HF) represents a major cause of morbidity and health care expenditure globally, 1 and increases the risk for sudden cardiac death (SCD). In the USA, about 325 000 adults die from SCD every year, accounting for half of all cardiovascular deaths. 2 The implantable cardioverter-defibrillator (ICD) is currently indicated for primary SCD prophylaxis in patients with severe left ventricular systolic dysfunction, irrespective of the underlying aetiology. 3,4 The recent results of the Danish Study to Assess the Efficacy of ICDs in Patients with Non-Ischaemic Systolic Heart Failure on Mortality (DANISH) 5 raised novel interest in the longstanding debate on the efficacy of ICD implantation in non-ischaemic dilated cardiomyopathy (NIDCM). In fact, the DANISH study found only a slightly lower, non-statistically significant (P = 0.28) reduction in the primary endpoint of all-cause mortality in NIDCM patients randomized to ICD implantation (21.6%) compared with the control group (23.4%) treated with optimal medical management but no ICD implantation over a median follow-up of 67.6 months ( Figure 1A). These results add further evidence to the findings of previous studies with conflicting results, such as the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) 6 and the Defibrillators in Non-Ischaemic Cardiomyopathy Treatment Evaluation (DEFINITE) study. 7 In order to resolve this still debated issue, in-depth analyses of these studies are required to disentangle the reasons underlying the differences observed across the results of individual studies. In fact, although the authors of the DANISH study concluded that ICD implantation is not associated with an overall survival benefit in patients with NIDCM, 5 perusal of the secondary endpoints shows that the frequency of SCD was almost halved in the ICD arm (4.3% vs. 8.2%; P = 0.005) ( Figure 1B). This latter finding raises doubts about the current strategy of defibrillator implantation for the primary prevention of SCD. In fact, although not statistically significant, hazard ratios (HRs) for all-cause death and cardiovascular death were 0.87 and 0.77, respectively, both in favour of ICD implantation. 5 However, the benefits to be gained from ICD use should be weighed against the risks for complications and side effects. Moreover, the differential impact of ICD on different modes of death should also be taken into account in studies evaluating ICD effectiveness. 8 In fact, a comprehensive evaluation of all key elements in play represents the best strategy for identifying predictors of success and failure of ICD therapy. Additionally, the results of the DANISH study 5 highlight the importance of stratifying patients according to level of risk. A subgroup analysis in the DANISH study revealed a significant reduction of the primary endpoint in specific patient categories, such as in younger patients (<59 years; P = 0.02) and in those with less severe HF (NT-proBNP <1177 pg/mL; P = 0.02), 5 although it should be noted that these results do not provide sufficient evi...

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Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure

Elsner,

Bettin,

Tilz

et al. 2024

Curr Heart Fail Rep

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A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

Cited by 11 publications

References 41 publications

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

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

Should we rethink the indications for implantable cardioverter‐defibrillators in non‐ischaemic dilated cardiomyopathy?

Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure

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