Cost-effectiveness of cardiac resynchronization therapy in patients with heart failure: The perspective of a middle-income country's public health system

Bertoldi, Eduardo Gehling; Rohde, Luís Eduardo Paim; Zimerman, Leandro Ioschpe; Pimentel, Maurício; Polanczyk, Carísi Anne

doi:10.1016/j.ijcard.2011.06.046

Cited by 31 publications

(36 citation statements)

References 31 publications

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“…The selected studies included economic models adapting perspectives of four European health care systems (Belgium, Germany, Spain and UK) [11–15, 17, 18] as well that of a middle income country (Brazil) [16]. …”

Section: Resultsmentioning

confidence: 99%

“…Bertoldi et al [16] linked successful implantation of the device (CRT-P, CRT-D or ICD) to complications or no-complications after implantation, which then led to the long-term model. Failure of implantation led to the long-term OPT strategy.…”

Section: Resultsmentioning

confidence: 99%

“…In Yao et al [12] patients that remained alive in the next time period could continue being in the same NYHA class or move to higher or lower NYHA classes. Similarly, in Bertoldi et al [16] patients could move between NYHA classes (but with only a NHYA class at a time).…”

Section: Resultsmentioning

confidence: 99%

“…Both trials used similar eligibility criteria for the selection of patients [1, 2]. Bertoldi et al [16] used data from an outpatient clinic in a Brazilian hospital but reported a similar target population. Colquitt et al [18] used data from the MADIT-CRT [21] and RAFT [22] trials for the comparison of CRT-D with ICD arms.…”

Section: Resultsmentioning

confidence: 99%

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

2016

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ObjectivesCardiac resynchronization therapy with a biventricular pacemaker (CRT-P) is an effective treatment for dyssynchronous heart failure (DHF). Adding an implantable cardioverter defibrillator (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, if the majority of patients do not require shock therapy, the cost-effectiveness ratio of CRT-D compared to CRT-P may be high. The objective of this study was to systematically review decision models evaluating the cost-effectiveness of CRT-D for patients with DHF, compare the structure and inputs of these models and identify the main factors influencing the ICERs for CRT-D.MethodsA comprehensive search strategy of Medline (Ovid), Embase (Ovid) and EconLit identified eight cost-effectiveness models evaluating CRT-D against optimal pharmacological therapy (OPT) and/or CRT-P.ResultsThe selected economic studies differed in terms of model structure, treatment path, time horizons, and sources of efficacy data. CRT-D was found cost-effective when compared to OPT but its cost-effectiveness became questionable when compared to CRT-P.ConclusionsCost-effectiveness of CRT-D may increase depending on improvement of all-cause mortality rates and HF mortality rates in patients who receive CRT-D, costs of the device, and battery life. In particular, future studies need to investigate longer-term mortality rates and identify CRT-P patients that will gain the most, in terms of life expectancy, from being treated with a CRT-D.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

2016

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“…Metanálise compilando quatro estudos, que incluíram pacientes em classes funcionais I e II, demonstrou que a TRV atuou na redução do risco relativo de morte de 20% frente ao tratamento clínico convencional ou ao implante isolado de CDI 197 . Estudo de custo efetividade demonstrou que a TRV é custo-efetiva no nosso meio enquanto a associação de CDI não é custo-efetiva 198 . Não existe estudo para a doença de Chagas, mas investigação recente demonstrou que a incidência de dissincronia interventricular nesta etiologia é de 34%, não tendo relação com a duração do QRS e nem com outros eventos 199 .…”

Section: Dispositivos Implantáveis Deunclassified

Atualização da Diretriz Brasileira de Insuficiência Cardíaca Crônica - 2012

2012

Arquivos Brasileiros De Cardiologia

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Improving the Methods for the Economic Evaluation of Medical Devices

et al. 2017

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Medical devices (MDs) have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organisational impact, that need to be considered when they are evaluated. This paper investigates how MDs have been assessed in practice, in order to identify methodological gaps that need to be addressed to improve the decision-making process for their adoption.We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist supplemented by some additional categories to assess the quality of reporting and consideration of the distinctive features of MDs. Two case studies were considered: transcatheter aortic valve implantation (TAVI) representing an emerging technology and implantable cardioverter defibrillators (ICDs) representing a mature technology. Economic evaluation studies published as journal articles or within Health Technology Assessment reports were identified through a systematic literature review. A total of 19 studies on TAVI and 41 studies on ICDs were analysed. Learning curve was considered in only 16% of studies on TAVI. Incremental innovation was more frequently mentioned in the studies of ICDs, but its impact was considered in only 34% of the cases. Dynamic pricing was the most recognised feature but was empirically tested in less than half of studies of TAVI and only 32% of studies on ICDs. Finally, organisational impact was considered in only one study of ICDs and in almost all studies on TAVI, but none of them estimated its impact.By their very nature, most of the distinctive features of MDs cannot be fully assessed at market entry. However, their potential impact could be modelled, based on the experience with previous MDs, in order to make a preliminary recommendation. Then, well-designed post-market studies could help in reducing uncertainties and make policymakers more confident to achieve conclusive recommendations.

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Cost-effectiveness of cardiac resynchronization therapy in patients with heart failure: The perspective of a middle-income country's public health system

Cited by 31 publications

References 31 publications

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

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

Atualização da Diretriz Brasileira de Insuficiência Cardíaca Crônica - 2012

Improving the Methods for the Economic Evaluation of Medical Devices

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