905 Cost Effectiveness of Cardiac Resynchronization Therapy (CRT) for Mild to Moderate Heart Failure

Abstract

BackgroundThe objective of this study was to assess the cost effectiveness of ICD-CRT versus ICD alone in patients with left ventricular dysfunction and a wide QRS complex. In a recent randomized controlled trial (RAFT), the addition of CRT to an implantable cardiodefibrillator (ICD) in this group of patients was shown to reduce rates of death and hospitalization for heart failure.MethodsAnalysis assessed the health care related costs and quality adjusted life years for both the ICD-CRT and ICD groups over a 40 year time horizon. The time horizon was facilitated by a Markov model developed by combining data for the 1798 patients enrolled within the RAFT with long term data on the longevity of the devices. Costs and benefits in terms of quality adjusted life years (QALYs) were discounted at 3% per annum. Health care resources included the initial device plus device replacements, cardiovascular and non cardiovascular related hospitalizations in addition to drug costs, physician visits and long term care. Resource use was weighted by appropriate unit costs from the USA. Uncertainty concerning cost effectiveness was assessed through Monte Carlo simulation and deterministic sensitivity analysis.ResultsModels for Canadian resource utilization and costing have been developed and are currently being conducted. For the US models, the use of ICD-CRT was estimated to lead to an average increase in costs of $35,308 and an average increase in QALYs of 1.07. The incremental cost per QALY gained was $33,025. ICD-CRT was not cost effective for patients with atrial fibrillation and those with preexisting ventricular pacing.ConclusionsICD-CRT is cost effective for the population studied within the RAFT clinical trial. BackgroundThe objective of this study was to assess the cost effectiveness of ICD-CRT versus ICD alone in patients with left ventricular dysfunction and a wide QRS complex. In a recent randomized controlled trial (RAFT), the addition of CRT to an implantable cardiodefibrillator (ICD) in this group of patients was shown to reduce rates of death and hospitalization for heart failure. The objective of this study was to assess the cost effectiveness of ICD-CRT versus ICD alone in patients with left ventricular dysfunction and a wide QRS complex. In a recent randomized controlled trial (RAFT), the addition of CRT to an implantable cardiodefibrillator (ICD) in this group of patients was shown to reduce rates of death and hospitalization for heart failure. MethodsAnalysis assessed the health care related costs and quality adjusted life years for both the ICD-CRT and ICD groups over a 40 year time horizon. The time horizon was facilitated by a Markov model developed by combining data for the 1798 patients enrolled within the RAFT with long term data on the longevity of the devices. Costs and benefits in terms of quality adjusted life years (QALYs) were discounted at 3% per annum. Health care resources included the initial device plus device replacements, cardiovascular and non cardiovascular related hospitalizations in addition to drug costs, physician visits and long term care. Resource use was weighted by appropriate unit costs from the USA. Uncertainty concerning cost effectiveness was assessed through Monte Carlo simulation and deterministic sensitivity analysis. Analysis assessed the health care related costs and quality adjusted life years for both the ICD-CRT and ICD groups over a 40 year time horizon. The time horizon was facilitated by a Markov model developed by combining data for the 1798 patients enrolled within the RAFT with long term data on the longevity of the devices. Costs and benefits in terms of quality adjusted life years (QALYs) were discounted at 3% per annum. Health care resources included the initial device plus device replacements, cardiovascular and non cardiovascular related hospitalizations in addition to drug costs, physician visits and long term care. Resource use was weighted by appropriate unit costs from the USA. Uncertainty concerning cost effectiveness was assessed through Monte Carlo simulation and deterministic sensitivity analysis. ResultsModels for Canadian resource utilization and costing have been developed and are currently being conducted. For the US models, the use of ICD-CRT was estimated to lead to an average increase in costs of $35,308 and an average increase in QALYs of 1.07. The incremental cost per QALY gained was $33,025. ICD-CRT was not cost effective for patients with atrial fibrillation and those with preexisting ventricular pacing. Models for Canadian resource utilization and costing have been developed and are currently being conducted. For the US models, the use of ICD-CRT was estimated to lead to an average increase in costs of $35,308 and an average increase in QALYs of 1.07. The incremental cost per QALY gained was $33,025. ICD-CRT was not cost effective for patients with atrial fibrillation and those with preexisting ventricular pacing. ConclusionsICD-CRT is cost effective for the population studied within the RAFT clinical trial. ICD-CRT is cost effective for the population studied within the RAFT clinical trial.