Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Symptomatic Heart Failure

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Abstract
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. To assess the incremental cost-effectiveness of cardiac resynchronization therapy. Markov model with Monte Carlo simulation. Future costs and effects were discounted at 3%. 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. Patients with reduced ventricular function and prolonged QRS. Lifetime. U.S. health care system. Cardiac resynchronization therapy versus medical therapy. Quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness. 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, $79 800 to $156 500) per additional QALY. Results were sensitive to changes in several variables, including the relative risk for death or hospitalization. These results apply to patients who meet the inclusion criteria of the currently completed trials. 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.

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