Cost Effectiveness of Cardiac Resynchronization Therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial

Feldman, Arthur M.; Lissovoy, Gregory de; Bristow, Michael R.; Saxon, Leslie A.; Marco, Teresa De; Kass, David A.; Boehmer, John; Singh, Steven; Whellan, David J.; Carson, Peter E.; Boscoe, Audra; Baker, Timothy; Gunderman, Matthew

doi:10.1016/j.jacc.2005.08.033

Cited by 165 publications

(87 citation statements)

References 29 publications

(23 reference statements)

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“…Inclusion criteria included NYHA functional class III or IV plus a HF treatment in the preceding 12 months over and above other criteria. The ICERs for CRT‐P and CRT‐D vs. optimal medical therapy were US$19 600 and US$43 000, respectively, over a 7‐year time horizon 44. Using the CPI for medical care inflation of an average of 4.03%, the ICER for CRT‐P vs. optimal medical therapy and CRT‐D vs. optimal medical therapy would be US$27 513/QALY and US$60 360/QALY, respectively.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

Martinson

Bharmi

Dalal

et al. 2016

European J of Heart Fail

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AimsHaemodynamic‐guided heart failure (HF) management effectively reduces decompensation events and need for hospitalizations. The economic benefit of clinical improvement requires further study.Methods and resultsAn estimate of the cost‐effectiveness of haemodynamic‐guided HF management was made based on observations published in the randomized, prospective single‐blinded CHAMPION trial. A comprehensive analysis was performed including healthcare utilization event rates, survival, and quality of life demonstrated in the randomized portion of the trial (18 months). Markov modelling with Monte Carlo simulation was used to approximate comprehensive costs and quality‐adjusted life years (QALYs) from a payer perspective. Unit costs were estimated using the Truven Health MarketScan database from April 2008 to March 2013. Over a 5‐year horizon, patients in the Treatment group had average QALYs of 2.56 with a total cost of US$56 974; patients in the Control group had QALYs of 2.16 with a total cost of US$52 149. The incremental cost‐effectiveness ratio (ICER) was US$12 262 per QALY. Using comprehensive cost modelling, including all anticipated costs of HF and non‐HF hospitalizations, physician visits, prescription drugs, long‐term care, and outpatient hospital visits over 5 years, the Treatment group had a total cost of US$212 004 and the Control group had a total cost of US$200 360. The ICER was US$29 593 per QALY.ConclusionsStandard economic modelling suggests that pulmonary artery pressure‐guided management of HF using the CardioMEMS™ HF System is cost‐effective from the US‐payer perspective. This analysis provides the background for further modelling in specific country healthcare systems and cost structures.

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Section: Discussionmentioning

confidence: 99%

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

Martinson

Bharmi

Dalal

et al. 2016

European J of Heart Fail

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“…Analyses of controlled trials have shown the time dependency of the beneficial effects of ICDs on mortality, with a lack of benefit in the first months after implantation and an exponential rise in benefit thereafter reaching a peak after 3 years [65]. Accordingly, economic analyses have shown that it may need up to 6-7 years of follow-up to be cost effective [66,67]. Thus, ICDs may not be indicated in patients with ACHF and a predicted short life expectancy.…”

Section: Implantable Cardioverter Defibrillator (Icd)mentioning

confidence: 99%

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

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

352

242

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Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition.Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction b 30%, pseudonormal or restrictive mitral inflow pattern at Dopplerechocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance b 300 m or a peak oxygen uptake b 12-14 ml/kg/min; 5) history of N1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.

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“…These figures are well within the benchmark of 50 000 USD per QALY gained that has been used to delineate the upper margin for cost-effective healthcare interventions in the USA, and similar thresholds that are accepted in Europe. By contrast, the costeffectiveness of using CRT-D instead of CRT-P is difficult to determine, given the limited data available, but has been estimated as 43 000 USD per QALY and 46 700 USD per life-year gained based on data from the COMPANION study [69]. In the REVERSE trial, CRT was found to be cost-effective at 14 278 EURO per QALY gained, indicating that this therapy is a cost-effective intervention even for patients with mildly symptomatic HF [70].…”

Section: Cost-effectivenessmentioning

confidence: 99%

Cardiac resynchronization therapy: a breakthrough in heart failure management

Ståhlberg

Lund

Zabarovskaja

et al. 2012

Journal of Internal Medicine

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Abstract. Stå hlberg M, Lund LH, Zabarovskaja S, Gadler F, Braunschweig F, Linde C (Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden). Cardiac resynchronization therapy: a breakthrough in heart failure management (Review). J Intern Med 2012; 272: 330-343.Heart failure is now considered an epidemic. In patients with heart failure, electrical and mechanical dyssynchrony, evident primarily as prolongation of the QRS-complex on the surface electrocardiogram, is associated with detrimental effects on the cardiovascular system at several levels. In the past 10 years, studies have demonstrated that by stimulating both cardiac ventricles simultaneously, or almost simultaneously [cardiac resynchronization therapy (CRT)], the adverse effects of dyssynchrony can be overcome. Here, we provide a comprehensive overview of different aspects of CRT including the rationale behind and evidence for efficacy of the therapy. Issues with regard to gender effects and patient follow-up as well as a number of unresolved concerns will also be discussed.

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Cost Effectiveness of Cardiac Resynchronization Therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial

Cited by 165 publications

References 29 publications

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

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

Cardiac resynchronization therapy: a breakthrough in heart failure management

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