Abstract
BackgroundThe CardioMEMS® sensor is a wireless pulmonary artery pressure device used for monitoring symptomatic heart failure (HF). The use of CardioMEMS was associated with a reduction of hospitalizations of HF patients, but the acquisition cost could be high in low-and-middle income countries. Evidence of cost-effectiveness is needed to help decision-makers to allocate resources according to “value for money”. This study is aimed at estimating the cost-effectiveness of CardioMEMS used in HF patients from the third-party payer perspective -Social Security (SS) and Private Sector (PS)- in Argentina.MethodsA Markov model was developed to estimate the cost-effectiveness of CardioMEMS versus usual medical care over a lifetime horizon. The model was applied to a hypothetical population of patients with HF functional class III with at least one hospitalization in the previous 12 months. The main outcome was the incremental cost-effectiveness ratio (ICER). To populate the model we retrieved clinical, epidemiological and utility parameters from the literature, whilst direct medical costs were estimated through a micro-costing approach (exchange rate USD 1 = ARS 76.95). Uncertainties in all parameters were assessed by deterministic, probabilistic and scenario sensitivity analysis.ResultsCompared with the usual medical care, CardioMEMS increased quality-adjusted life years (QALY) by 0.37 and increased costs per patient by ARS 1,081,703 for SS and ARS 919,051 for PS. The resultant ICER was ARS 2,937,756 per QALY and ARS 2,496,015 per QALY for SS and PS, respectively. ICER was most sensitive to the hazard ratio of HF hospital admission and the acquisition price of CardioMEMS. The probability that CardioMEMS is cost-effective at one (ARS 700,473), three (ARS 2,101,419,) and five (ARS 3,502,363) Gross Domestic Product per capita is 0.6, 17.9 and 64.1% for SS and 5.4, 33.3 and 73.2% for PS.ConclusionsCardioMEMS was more effective and more costly than usual care in class III HF patients. Since in Argentina there is no current explicit threshold, the final decision to determine its cost-effectiveness will depend on the willingness-to-pay for QALYs in each health subsector.
Highlights
The CardioMEMS® sensor is a wireless pulmonary artery pressure device used for monitoring symp‐ tomatic heart failure (HF)
The effectiveness of remote monitoring depend on the particular device and patients’ characteristics [17, 18], remote monitoring of pulmonary artery pressure (PAP) in patients with HF can enable medical professionals to access to additional pathophysiological information and improve decision-making to prevent hospitalizations and slow the progression of symptomatic HF [19,20,21,22,23]
WA) to determine the cost-effectiveness of the use of CardioMEMS HF system compared to the usual medical care over a lifetime horizon, from the third-party payer perspective, in particular, for Social Security (SS) and Private Sector (PS) in Argentina
Summary
The CardioMEMS® sensor is a wireless pulmonary artery pressure device used for monitoring symp‐ tomatic heart failure (HF). There is an increasing use of pharmacological [3,4,5,6,7,8,9] and intracardiac device [10,11,12,13] therapy options that showed improved morbidity and mortality, HF is still a major burden to patients, their caregivers and the national healthcare systems. The effectiveness of remote monitoring depend on the particular device and patients’ characteristics [17, 18], remote monitoring of PAP in patients with HF can enable medical professionals to access to additional pathophysiological information and improve decision-making to prevent hospitalizations and slow the progression of symptomatic HF [19,20,21,22,23]
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