Optimisation of cardiac resynchronisation therapy device selection guided by cardiac magnetic resonance imaging: Cost-effectiveness analysis

Abstract

Background A recent study showed that the presence and characteristics of myocardial scar could independently predict appropriate implantable cardioverter-defibrillator therapies and the risk of sudden cardiac death in patients receiving a de novo cardiac resynchronisation device. Design The aim was to evaluate the cost-effectiveness of cardiac magnetic resonance imaging-based algorithms versus clinical practice in the decision-making process for the implantation of a cardiac resynchronisation device pacemaker versus cardiac resynchronisation device implantable cardioverter-defibrillator device in heart failure patients with indication for cardiac resynchronisation therapy. Methods An incidental Markov model was developed to simulate the lifetime progression of a heart failure patient cohort. Key health variables included in the model were New York Heart Association functional class, hospitalisations, sudden cardiac death and total mortality. The analysis was done from the healthcare system perspective. Costs (€2017), survival and quality-adjusted life years were assessed. Results At 5-year follow-up, algorithm I reduced mortality by 39% in patients with a cardiac resynchronisation device pacemaker who were underprotected due to misclassification by clinical protocol. This approach had the highest quality-adjusted life years (algorithm I 3.257 quality-adjusted life years; algorithm II 3.196 quality-adjusted life years; clinical protocol 3.167 quality-adjusted life years) and the lowest lifetime costs per patient (€20,960, €22,319 and €28,447, respectively). Algorithm I would improve results for three subgroups: non-ischaemic, New York Heart Association class III–IV and ≥65 years old. Furthermore, implementing this approach could generate an estimated €702 million in health system savings annually in European Society of Cardiology countries. Conclusion The application of cardiac magnetic resonance imaging-based algorithms could improve survival and quality-adjusted life years at a lower cost than current clinical practice (dominant strategy) used for assigning cardiac resynchronisation device pacemakers and cardiac resynchronisation device implantable cardioverter-defibrillators to heart failure patients.

Economic evaluations of big data analytics for clinical decision-making: a scoping review

“…Eight studies presented predictive analytics for 7 different types of imaging data (CT, MRI, Chest radiographs, digital cervical smears, mammographies, digital photographs, and ventilation-perfusion lung scans). 72–79 The number of full economic evaluations 73 , 75–77 , 79 and studies performed after development 73–76 , 78 were both higher than the first group of papers that used medical history data. Four studies measured effects in (quality-adjusted) life-years, 73 , 75–77 and more than half of the studies included implementation costs of analytics.…”

“… 72–79 The number of full economic evaluations 73 , 75–77 , 79 and studies performed after development 73–76 , 78 were both higher than the first group of papers that used medical history data. Four studies measured effects in (quality-adjusted) life-years, 73 , 75–77 and more than half of the studies included implementation costs of analytics. 73–77 The number of studies that found the analytics could lead to cost-savings was once again quite high (63%).…”

“…Four studies measured effects in (quality-adjusted) life-years, 73 , 75–77 and more than half of the studies included implementation costs of analytics. 73–77 The number of studies that found the analytics could lead to cost-savings was once again quite high (63%). 72–74 , 78 , 79 Just like the studies that used medical history data, authors of studies in this category emphasized the need for further validation prior to implementation.…”

“… 72 However, only a handful of papers included the costs of the analytics. 73 , 74 , 76 , 87 , 94 , 96 …”

Cardiac MRI in patients undergoing resynchronization therapy: Worth it all?

“…In this issue of the journal, Crespo and colleagues present a cost-effectiveness analysis performed on 181 patients of the GAUDI-CRT study. 6 Using a Markov model to simulate the progression of heart failure, they tested during a longer follow-up (four years) the hypothesis that a CMR-based approach for CRT-candidate screening could be more cost-effective than the simple clinical evaluation. And results proved they were right.…”