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.
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: Mattias Neyt; Serge Stroobandt; Caroline Obyn; Cécile Camberlin; Stephan Devriese; Chris De Laet; Hans Van Brabandt Journal: BMJ Open Date: 2011-01-01 Impact factor: 2.692