Log in to MyACC
Cost-Effectiveness of Implantable Cardiac Devices
Study Questions:
What is the cost-effectiveness of implantable-cardioverter defibrillators (ICDs), cardiac resynchronization therapy pacemakers (CRT-Ps), and cardiac resynchronization therapy defibrillators (CRT-Ds)?
Methods:
Individual patient data from 13 randomized trials were pooled. A series of regression equations were used to predict baseline all-cause mortality, hospitalization rates, health-related quality of life, and device-related treatment effects. A UK National Health Service perspective and a lifetime time horizon were used. Benefits were expressed as quality-adjusted life-years (QALYs). Results were reported for 24 subgroups based on left bundle branch block (LBBB) status, QRS duration, and New York Heart Association (NYHA) class.
Results:
At a threshold of £30,000 per QALY gained, CRT-D was cost-effective in 10 of the 24 subgroups including all LBBB morphology patients with NYHA class I/II/III. ICD was cost-effective for all non-NYHA class IV patients with QRS duration <120 ms and for NYHA class I/II non-LBBB morphology patients with QRS duration between 120 ms and 149 ms. CRT-P was also cost-effective in all NYHA class III/IV patients with QRS duration >120 ms. Device therapy is cost-effective in most patient groups with LBBB at a threshold of £20,000 per QALY gained.
Conclusions:
The authors concluded that at a threshold of £30,000 per QALY gained, CRT-D is cost-effective in a far wider group than previously recommended in the UK. In some subgroups, ICDs and CRT-Ps remain the cost-effective choice.
Perspective:
The findings from this robust study were used to inform the British National Institute for Health and Care Excellence (NICE) guidelines, expanding them to a wider group of patients. Recent advances in average device longevity and a competitive device marketplace will further enhance cost-effectiveness.
Keywords: Arrhythmias, Cardiac, Bundle-Branch Block, Cardiac Resynchronization Therapy, Cost-Benefit Analysis, Defibrillators, Implantable, Heart Failure, Systolic, National Health Programs, Pacemaker, Artificial, Quality of Life, Quality-Adjusted Life Years
< Back to Listings
