International Journal of Technology Assessment in Health Care

ASSESSMENTS

COST-EFFECTIVENESS ANALYSIS OF CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH NYHA I AND NYHA II HEART FAILURE IN SPAIN

Luis Almenara1, Beatriz Díaza2, Aurelio Quesadaa3, Carlos Crespoa4, Belén Martía5, Stuart Mealinga6, Cecilia Lindea7 and Claude Dauberta8

a1 Cardiology Department, Hospital Universitario La Fe

a2 Cardiology Department, Hospital Universitario Central de Asturias

a3 Cardiology Department, Hospital General de Valencia

a4 Department of statistics, University of Barcelona Oblikue Consulting

a5 Health Economics and Reimbursement, Medtronic Ibérica

a6 Oxford Outcomes

a7 Department of Cardiology, Karolinska University Hospital

a8 Département de Cardiologie et maladies vasculaires, CHU

Abstract

Objectives: The aim of the study was to combine clinical results from the European Cohort of the REVERSE study and costs associated with the addition of cardiac resynchronization therapy (CRT) to optimal medical therapy (OMT) in patients with mild symptomatic (NYHA I-II) or asymptomatic left ventricular dysfunction and markers of cardiac dyssynchrony in Spain.

Methods: A Markov model was developed with CRT + OMT (CRT-ON) versus OMT only (CRT-OFF) based on a retrospective cost-effectiveness analysis. Raw data was derived from literature and expert opinion, reflecting clinical and economic consequences of patient's management in Spain. Time horizon was 10 years. Both costs (euro 2010) and effects were discounted at 3 percent per annum.

Results: CRT-ON showed higher total costs than CRT-OFF; however, CRT reduced the length of hospitalization in ICU by 94 percent (0.006 versus 0.091 days) and general ward in by 34 percent (0.705 versus 1.076 days). Surviving CRT-ON patients (88.2 percent versus 77.5 percent) remained in better functional class longer, and they achieved an improvement of 0.9 life years (LYGs) and 0.77 years quality-adjusted life years (QALYs). CRT-ON proved to be cost-effective after 6 years, except for the 7th year due to battery depletion. At 10 years, the results were €18,431 per LYG and €21,500 per QALY gained. Probabilistic sensitivity analysis showed CRT-ON was cost-effective in 75.4 percent of the cases at 10 years.

Conclusions: The use of CRT added to OMT represents an efficient use of resources in patients suffering from heart failure in NYHA functional classes I and II.

Keywords:

  • Cardiac resynchronization therapy;
  • REVERSE;
  • Cost-effectiveness analysis;
  • Left ventricle;
  • Heart failure