Valutazione economica della resincronizzazione cardiaca nei pazienti affetti da scompenso cardiaco moderato-avanzato

Cardiac Resynchronization Therapy (CRT) in Heart Failure—A Model to Assess the Economic Value of this New Medical Technology

“…This assumption is comparable to that of two recently published randomized CRT trials [19,23]. For the follow‐up periods (at 6 months and 12 months) we assumed that the average NYHA class score will improve in the CRT group to a value of 2.1 based on consistent findings reported in various studies [19,27–29]. As concerns the group treated with OPT alone, it was assumed that no such improvement will occur because these patients are already receiving the most efficient pharmacological therapy.…”

“…We would like to emphasize that our illustrative findings are substantially more conservative than results obtained from three economic studies with a pre–post design, which all showed evidence that CRT may even be cost saving within 1 year [21,27,34]. All of these studies, however, used clearly more favorable data regarding reduction of hospitalization than those reported in the available two randomized comparative landmark CRT trials [19,23].…”

“…For the validation of the economic part of the model, data from the Brescia study [27] were entered into the model to compare the outcomes generated by the model with that reported in the article. The difference in the economic findings was minor, which proves the model to be valid.…”

“…These most sensitive parameters include the length of hospital stay, the unit cost per hospital day, the reduction in the probability of hospitalization after CRT, the CRT implantation cost, and the distribution of patients into the different NYHA classes. The worst case scenario is therefore based on assumptions that imply decreased clinical and economic benefits of CRT: a smaller reduction in the average length of hospital stay for a CRT patient relative to an OPT patient of only 40% (9.3 vs. 15.5 days; base case assumption: 55%), a 20% lower unit cost each for an ICU and a cardiology ward day reflecting charges of a mid‐sized hospital (€750 and €270, respectively), no change from the base case value for the reduction of hospital admissions in the CRT group because MIRACLE already shows a conservative finding when compared with other studies [21,27,34], an 10% increased cost of the CRT procedure (€8250 vs. €7500 including the index hospital stay) as the base case value reflects an estimate, and an assumed post‐CRT improvement in the average NYHA class of only 0.8 (from 3.1 to 2.3; baseline assumption: 3.1 to 2.1). The best case scenario takes into account a higher reduction in the average length of hospital stay per admission for a CRT patient relative to an OPT patient of 77% (assumption: 3.5 vs. 15.5 days) as reported in a recent analysis [34], a 20% higher unit cost each for an ICU and a cardiology ward day reflecting charges applicable to a university hospital (€1130 and €410, respectively), a reduction of hospital admissions related to CRT implantation of 80% (base case value 48%) as observed in three economically oriented studies [21,27,34], a 10% decreased cost of the CRT procedure (€6750 including the associated hospital stay), and an improvement in the average NYHA class by 1.2 (from 3.1 to 1.9 as reported in the PATH‐CHF trial).…”