Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure

Graham Nichol, Padma Kaul, Ella Huszti, John F P Bridges

Research output: Contribution to journalArticle

Abstract

Background: Heart failure is a common, costly, and debilitating illness. Resynchronization of ventricular contraction in patients with heart failure improves ejection fraction. The long-term morbidity and costs associated with such cardiac resynchronization therapy remain unclear. Objective: To assess the incremental cost-effectiveness of cardiac resynchronization therapy. Design: Markov model with Monte Carlo simulation. Future costs and effects were discounted at 3%. Data Sources: Effects data were obtained from a concurrent systematic review. Health-related quality-of-life and cost data were obtained from publicly available data or from surveys. Target Population: Patients with reduced ventricular function and prolonged QRS. Time Horizon: Lifetime. Perspective: U.S. health care system. Interventions: Cardiac resynchronization therapy versus medical therapy. Outcome Measures: Quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness. Results of Base-Case Analysis: Medical therapy yielded a median of 2.64 (interquartile range, 2.47 to 2.82) discounted QALYs and a median discounted lifetime cost of $34 400 (interquartile range, $31 100 to $37 700). Cardiac resynchronization therapy was associated with a median incremental cost of $107 800 (interquartile range, $79800 to $156 500) per additional QALY. Results of Sensitivity Analysis: Results were sensitive to changes in several variables, including the relative risk for death or hospitalization. Limitations: These results apply to patients who meet the inclusion criteria of the currently completed trials. Conclusions: The incremental cost per QALY for cardiac resynchronization is similar to that of other commonly used interventions but is sensitive to changes in several key variables. Resynchronization therapy should not be considered in patients with comorbid illness that shortens life expectancy.

Original languageEnglish (US)
JournalAnnals of Internal Medicine
Volume141
Issue number5
StatePublished - Sep 7 2004
Externally publishedYes

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Cardiac Resynchronization Therapy
Cost-Benefit Analysis
Heart Failure
Quality-Adjusted Life Years
Costs and Cost Analysis
Concurrent Review
Ventricular Function
Health Services Needs and Demand
Information Storage and Retrieval
Life Expectancy
Hospitalization
Therapeutics
Quality of Life
Outcome Assessment (Health Care)
Morbidity
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)

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Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure. / Nichol, Graham; Kaul, Padma; Huszti, Ella; Bridges, John F P.

In: Annals of Internal Medicine, Vol. 141, No. 5, 07.09.2004.

Research output: Contribution to journalArticle

Nichol, Graham ; Kaul, Padma ; Huszti, Ella ; Bridges, John F P. / Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure. In: Annals of Internal Medicine. 2004 ; Vol. 141, No. 5.
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