Adding CRT to ICD therapy for mild HF can be cost-effective
Adding cardiac resynchronization therapy to an implantable cardioverter defibrillator appears to be cost-effective in patients with mild HF, according to an analysis published in the Annals of Internal Medicine.
Compared with an ICD alone, adding CRT to an ICD (CRT-D) is more likely to be cost-effective for those with NYHA Class II symptoms than NYHA Class I symptoms because of a more certain mortality benefit, researchers concluded.
Previous analyses indicated that adding CRT to an ICD in patients with moderate-to-severe HF is cost-effective, but “the potential value of adding CRT to an ICD is less clear for patients with mild [HF],” the researchers wrote.
Christopher Y. Woo, MD, and colleagues designed a model to assess the cost-effectiveness of CRT-D compared with an ICD alone in patients aged 65 years or older with mild HF, defined as left ventricular ejection fraction of 30% or lower, QRS duration of 120 milliseconds or greater and NYHA Class I or II symptoms. The model incorporated data from clinical trials and registries, CMS claims data and life tables from the CDC to calculate life-years, quality-adjusted life-years (QALYs), care costs and incremental cost-effectiveness ratios.
In a base-case analysis, Woo, from the division of cardiovascular medicine at Stanford University School of Medicine, and colleagues determined that CRT-D resulted in increased life expectancy (9.8 years vs. 8.8 years) and a greater number of QALYs (8.6 vs. 7.6) compared with ICDs alone, along with higher costs ($286,500 vs. $228,600). They calculated the cost per QALY gained as $61,700.
Results from sensitivity analyses, indicated that the degree of mortality reduction had a major impact on CRT-D cost-effectiveness: For example, a 0.95 risk ratio for death yielded a higher incremental cost-effectiveness ratio of $119,600 per QALY.
Other factors negatively influencing cost-effectiveness included higher costs for CRT-D devices, shorter battery life and advanced patient age, they wrote.
“This finding depends on a CRT-D providing a mortality benefit and is thus most applicable to patents with NYHA Class II symptoms and a QRS duration greater than 150 milliseconds or [left bundle branch block],” they wrote. “Given that such a survival benefit has not yet been established in patients with NYHA Class I symptoms, the cost-effectiveness of CRT-D in this setting remains uncertain.” – by Erik Swain
Disclosure: Woo reports no relevant financial disclosures. Two other researchers report receiving personal fees from Zoll LifeVest.