Comprehensive Economic Evaluation of Automatic Optimization in Cardiac Resynchronization Defibrillators (CRT-Ds): Cost-Effectiveness Analysis - A Canadian Perspective

Abstract

Introduction Innovative algorithms allowing automated optimization of cardiac resynchronization therapy defibrillators (CRT-Ds), have been introduced in Canada. These automatically adjust the A-V interval and appropriately withhold right ventricular (RV) pacing during times it may not be needed. These “adaptive” algorithms may increase response to therapy, as network meta-analyses have demonstrated, reduce hospitalizations, and drastically reduce the need of periodic ultrasound-driven device optimization. We wanted to investigate the cost-effectiveness of these algorithms from a Canadian provincial Healthcare system. Methods Markov Modelling informed by the AdaptivCRT Clinical Trial and propensity score matching with earlier CRT-D trials. Costs of device implantations were achieved from Ontario Case Costing Initiative. Other costs were obtained through Canadian literature reviews. 3% discounting of costs and outcomes was applied. Results The predicted patient survival was 10.97 years with adaptive algorithms and 10.50 years with traditional CRT, a 4.5% increase over lifetime. Deterministic results suggested adaptive algorithms produce 0.31 quality-adjusted life years (QALYs) more than traditional CRT (7.41 vs. 7.10). The cost saving per life-year gained with adaptive algorithms was CAD 2,118.47. The cost saving per QALY was CAD 3,133.83. Conclusions The use of adaptive algorithms was projected to improve average patient survival, quality of life, while avoiding costs. Avoidance of AF-related admissions and cardiac ultrasounds will make the benefits more pronounced.