PMID- 21112898
OWN - NLM
STAT- MEDLINE
DCOM- 20120106
LR  - 20110704
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Linking)
VI  - 32
IP  - 13
DP  - 2011 Jul
TI  - Cost-effectiveness of cardiac resynchronization therapy in patients with 
      asymptomatic to mild heart failure: insights from the European cohort of the 
      REVERSE (Resynchronization Reverses remodeling in Systolic Left Ventricular 
      Dysfunction).
PG  - 1631-9
LID - 10.1093/eurheartj/ehq408 [doi]
AB  - AIMS: To assess the cost-effectiveness of cardiac resynchronization therapy (CRT) 
      compared with optimal medical therapy in patients with New York Heart Association 
      (NYHA) II heart failure (HF) or NYHA I with previous HF symptoms. METHODS AND 
      RESULTS: A proportion in state model with Monte Carlo simulation was developed to 
      assess the costs, life years and quality-adjusted life year (QALYs) associated 
      with CRT-ON and -OFF over a 10 year time period. Data from 262 patients in the 
      European cohort of the REVERSE clinical trial (QRS >/= 120 ms, left ventricular 
      ejection fraction </= 40%, CRT-ON, n = 180, CRT-OFF, n = 82) were used to model 
      all-cause mortality, change in NYHA class and resource use. EQ-5D preference 
      weights were taken from a previous cost-effectiveness model of CRT and unit costs 
      from national UK databases. Costs and benefits were discounted at 3.5% p.a. 
      Extensive deterministic and probabilistic sensitivity analyses were performed. 
      Compared with CRT-OFF, 0.94 life years or 0.80 QALYs were gained in the CRT ON 
      group at an additional cost of euro11 455, yielding an incremental 
      cost-effectiveness ratio of euro14.278 per quality-adjusted life year (QALY) gained. 
      At a threshold of euro33 000 ( pound30 000) per QALY gained, the probability that CRT is 
      cost-effective is 79.6%. Cardiac resynchronization therapy becomes cost effective 
      after  approximately 4.5 years. Cardiac resynchronization therapy needs only to demonstrate a 
      modest impact on all cause mortality (hazard ratio = 0.82) in order to 
      demonstrate cost-effectiveness. The results are robust to changes in all other 
      parameters. CONCLUSION: Cardiac resynchronization therapy is a cost-effective 
      intervention for patients with mildly symptomatic HF and for asymptomatic 
      patients with left ventricular dysfunction and previous HF symptoms.
FAU - Linde, Cecilia
AU  - Linde C
AD  - Department of Cardiology, Karolina University Hospital, Stockholm, Sweden.
FAU - Mealing, Stuart
AU  - Mealing S
FAU - Hawkins, Neil
AU  - Hawkins N
FAU - Eaton, James
AU  - Eaton J
FAU - Brown, Ben
AU  - Brown B
FAU - Daubert, Jean-Claude
AU  - Daubert JC
CN  - REVERSE study group
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20101125
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
SB  - IM
CIN - Eur Heart J. 2011 Jul;32(13):1580-2. PMID: 21324935
MH  - Aged
MH  - Cardiac Resynchronization Therapy/*economics/methods
MH  - Cost-Benefit Analysis
MH  - Defibrillators, Implantable/*economics
MH  - Double-Blind Method
MH  - Heart Failure/economics/*therapy
MH  - Hospitalization/economics
MH  - Humans
MH  - Middle Aged
MH  - Prospective Studies
MH  - Quality-Adjusted Life Years
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/economics/*therapy
MH  - Ventricular Remodeling/physiology
EDAT- 2010/11/30 06:00
MHDA- 2012/01/10 06:00
CRDT- 2010/11/30 06:00
PHST- 2010/11/30 06:00 [entrez]
PHST- 2010/11/30 06:00 [pubmed]
PHST- 2012/01/10 06:00 [medline]
AID - ehq408 [pii]
AID - 10.1093/eurheartj/ehq408 [doi]
PST - ppublish
SO  - Eur Heart J. 2011 Jul;32(13):1631-9. doi: 10.1093/eurheartj/ehq408. Epub 2010 Nov 
      25.