International Journal of Technology Assessment in Health Care



Rosana Poggioa1, Federico Augustovskya2, Joaquín Caporalea2, Vilma Irazolaa2 and Santiago Miriukaa3

a1 Institute for Clinical Effectiveness and Health Policy (IECS); Department of Cardiology, FLENI Foundation email:

a2 Institute for Clinical Effectiveness and Health Policy (IECS)

a3 Department of Cardiology, FLENI Foundation; CONICET


Objectives: Cardiac resynchronization therapy (CRT) has recently been shown to reduce both mid-term and long-term mortality in patients with mild heart failure. Although proven effective, it is unclear whether CRT is cost-effective in low and middle-income countries (LMIC). Therefore, we set out to analyze the cost-effectiveness of CRT in Argentina in patients with New York Heart Association (NYHA) functional class (FC) I or II heart failure (HF). We chose to compare patients receiving optimal medical treatment (OMT) and CRT with those patients receiving only OMT.

Methods: We constructed a Markov model with a cohort simulation, and a life-time horizon to assess costs, life-years, and quality-adjusted life-year (QALY) gained as a result of treatment with both CRT and OMT from an Argentine third party payer perspective. We included patients who met the following criteria: left ventricular ejection fraction (LVEF) ≤ 40 percent, sinus rhythm with a QRS ≥ 120 msec, and NYHA FC I-II HF. The results were expressed as cost per life-year and QALY gained in international dollars (ID$) for the year 2009.

Results: For the base case analysis performed, we started at a fixed age of 65. After applying a 3 percent annual discount rate, the incremental cost-effectiveness ratio (ICER) was 38.005 ID$ per year of life gained and 34.185 ID$ per QALY gained.

Conclusions: Long-term treatment with CRT appears to be cost-effective in Argentina compared with patients treated solely with OMT. Similar analysis should be performed to determine if this treatment option is cost-effective in other LMIC.


  • Cost-effectiveness;
  • Cardiac resynchronization therapy;
  • Markov model;
  • Quality-adjusted life years;
  • Heart failure


  This project did not receive any grants or funding.