The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator

Yao, Guiqing; Freemantle, Nick; Calvert, Melanie; Bryan, Stirling; Daubert, Jean‐Claude; Cleland, John G.F.

doi:10.1093/eurheartj/ehl382

Cited by 163 publications

(170 citation statements)

References 19 publications

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“…[16][17][18] The reduction in hospitalizations and hospitalization days with CRT therapy observed in RAFT would be anticipated to result in substantial healthcare savings, but the magnitude of this benefit awaits the completion of a detailed cost-effectiveness analysis. [16][17][18] Given that hospital stay may vary dramatically by geographic region, we examined the duration of hospital stay for HF by geographic region: Australia, Canada, Europe, and Turkey. 19 The average length of stay was similar between regions.…”

Section: Crt and Hospitalizations For Hfmentioning

confidence: 99%

Impact of Cardiac Resynchronization Therapy on Hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial

Gillis

Kerr

Philippon³

et al. 2014

Circulation

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4-8 The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) reported that patients with mild to moderate HF and depressed left ventricular systolic function in association with an intraventricular conduction delay randomized to an implantable cardioverter-defibrillator (ICD) plus CRT experienced improved survival and were significantly less likely to be hospitalized for HF compared with the group randomized to ICD therapy alone. 8 This prespecified study within RAFT presents a detailed analysis of the causes of hospitalization, hospitalization rates, and hospitalization lengths of stay in the RAFT cohort. Clinical Perspective on p 2030 MethodsThe study design 9 and results of RAFT 8 have previously been published. Patients were enrolled at 24 centers in Canada, 8 centers inBackground-This study reports the impact of cardiac resynchronization therapy (CRT) on hospitalizations in patients randomized to implantable cardioverter-defibrillator (ICD) or ICD-CRT in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). Methods and Results-Hospitalization rates and lengths of hospital stay were compared between the 2 groups. At the 18-month follow-up, the numbers of patients hospitalized for any cause were similar in the ICD (n=351, 38.8%) and ICD-CRT (n=331, 30.0%) groups. The number of patients hospitalized for heart failure was significantly lower in the ICD-CRT (n=101, 11.3%) compared with the ICD (n=141, 15.6%; P=0.003) group. The number of patients hospitalized for a device-related indication was similar in the ICD-CRT group (n=147, 16.4%) and ICD group (n=126, 13.9%; P=0.148). The total number of hospitalizations for any cause (n=1448 versus n=1553; P=0.042), any cardiovascular cause (n=667 versus n=790; P=0.017), and any heart failure cause (n=385 versus n=505; P<0.0001) was significantly lower in ICD-CRT group compared with the ICD group, whereas the number of hospitalizations for device-related causes was significantly higher in the ICD-CRT group compared with the ICD group (246 versus 159; P<0.001). Although the reduction in hospitalizations for heart failure in the CRT-ICD group was offset by an increased number of hospitalizations for device-related indications, the length of hospital stay for any cause was significantly shorter in the ICD-CRT group (8.83±13.30 days) compared with the ICD group (9.59±14.40 days; P=0.005). Conclusion-ICD-CRT therapy significantly reduces hospitalizations and total days in hospital in patients with New York Heart Association class II/III heart failure compared with ICD therapy despite increased admissions for device-related indications. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251251.

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Section: Crt and Hospitalizations For Hfmentioning

confidence: 99%

Impact of Cardiac Resynchronization Therapy on Hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial

Gillis

Kerr

Philippon³

et al. 2014

Circulation

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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

353

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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“…Only the COMPANION trial has directly compared the relative effectiveness of CRT‐D versus CRT‐P; it found lower risk of cardiac death for CRT‐D versus CRT‐P, but the trial was powered to compare each device to medical therapy alone, not to compare the 2 devices 12. CRT‐D devices are nearly 3 times more costly and require more frequent battery replacements compared with CRT‐P13; accordingly, cost‐effectiveness analyses have suggested that the incremental benefit of CRT‐D over CRT‐P may not justify the large cost difference 14, 15…”

mentioning

confidence: 99%

Geographic and Temporal Variation in Cardiac Implanted Electric Devices to Treat Heart Failure

Hatfield

Kramer

Volya

et al. 2016

JAHA

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BackgroundCardiac implantable electric devices are commonly used to treat heart failure. Little is known about temporal and geographic variation in use of cardiac resynchronization therapy (CRT) devices in usual care settings.Methods and ResultsWe identified new CRT with pacemaker (CRT‐P) or defibrillator generators (CRT‐D) implanted between 2008 and 2013 in the United States from a commercial claims database. For each implant, we characterized prior medication use, comorbidities, and geography. Among 17 780 patients with CRT devices (median age 69, 31% women), CRT‐Ps were a small and increasing share of CRT devices, growing from 12% to 20% in this study period. Compared to CRT‐D recipients, CRT‐P recipients were older (median age 76 versus 67), and more likely to be female (40% versus 30%). Pre‐implant use of β‐blockers and angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers was low in both CRT‐D (46%) and CRT‐P (31%) patients. The fraction of CRT‐P devices among all new implants varied widely across states. Compared to the increasing national trend, the share of CRT‐P implants was relatively increasing in Kansas and relatively decreasing in Minnesota and Oregon.ConclusionsIn this large, contemporary heart failure population, CRT‐D use dwarfed CRT‐P, though the latter nearly doubled over 6 years. Practice patterns vary substantially across states and over time. Medical therapy appears suboptimal in real‐world practice.

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The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator

Abstract: Long-term treatment with CRT-P appears cost-effective compared with MT alone. From a life-time perspective, assuming a reasonable life expectancy when receiving effective treatment for heart failure, CRT-ICD may also be considered cost-effective when compared with CRT-P + MT.

Cited by 163 publications

References 19 publications

Impact of Cardiac Resynchronization Therapy on Hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial

Impact of Cardiac Resynchronization Therapy on Hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure 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

Geographic and Temporal Variation in Cardiac Implanted Electric Devices to Treat Heart Failure

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