Is combined resynchronisation and implantable defibrillator therapy a cost-effective option for left ventricular dysfunction?

Abstract

OBJECTIVE:

To evaluate the cost-effectiveness of combined resynchronisation and implantable defibrillator therapy for left ventricular dysfunction and explore subgroups in which such devices might be most cost-effective.

DESIGN:

Markov model-based economic evaluation.

SETTING:

UK NHS.

PARTICIPANTS:

A simulated mixed age cohort of NYHA class III and IV patients with left ventricular systolic dysfunction and prolonged QRS interval.

MAIN OUTCOME MEASURES:

Cost per quality adjusted life year gained over the patient lifetime.

RESULTS:

The incremental cost-effectiveness of resynchronisation therapy alone compared with optimal medical therapy was pound16,735 (95% CI: pound14,630 to pound20,333) with a 91% probability of being cost-effective at a willingness to pay threshold of pound30,000. Compared with resynchronisation alone, the incremental cost-effectiveness of combined implantable defibrillator was pound40,160 (95% CI: pound26,645 to pound59,391) with only a 26% probability of cost-effectiveness at the pound30,000 threshold. In a direct comparison across three treatments (medical treatment, resynchronisation alone and combined resynchronisation with implantable defibrillator therapy) resynchronisation alone was found to be the most cost-effective option.

CONCLUSION:

Combined resynchronisation and implantable defibrillator therapy is not cost-effective for left ventricular dysfunction. Instead resynchronisation alone remains the most cost-effective policy option in this population. Combined devices are more likely to be cost-effective in the subgroups of younger patients or those with high risk of sudden cardiac death who would qualify for resynchronisation therapy.

• Authors: Mary Bond, Stuart Mealing, Rob Anderson, John Dean, Ken Stein, Rod S Taylor
• Journal: International journal of cardiology (Int J Cardiol) Vol. 137 Issue 3 Pg. 206-15 (Nov 12 2009) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 18703244 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cardiac Pacing, Artificial (economics)
• Cost-Benefit Analysis
• Death, Sudden, Cardiac (epidemiology, prevention & control)
• Defibrillators, Implantable (economics)
• Electric Power Supplies
• Female
• Humans
• Male
• Markov Chains
• Middle Aged
• Models, Economic
• Quality-Adjusted Life Years
• Technology Assessment, Biomedical (economics)
• Treatment Outcome
• Ventricular Dysfunction, Left (mortality, therapy)