PMID- 22021894
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20111110
LR  - 20211020
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 1
IP  - 2
DP  - 2011 Jan 1
TI  - Cost-effectiveness of cardiac resynchronisation therapy for patients with 
      moderate-to-severe heart failure: a lifetime Markov model.
PG  - e000276
LID - 10.1136/bmjopen-2011-000276 [doi]
LID - e000276
AB  - Objective To assess the cost-effectiveness of cardiac resynchronisation therapy 
      (CRT) both with CRT-P (biventricular pacemaker only) and with CRT-D 
      (biventricular pacemaker with defibrillator) in patients with New York Heart 
      Association (NYHA) functional class III/IV from a Belgian healthcare-payer 
      perspective. Methods A lifetime Markov model was designed to calculate the 
      cost-utility of both interventions. In the reference case, the treatment effect 
      was based on the Comparison of Medical Therapy, Pacing and Defibrillation in 
      Heart Failure trial. Costs were based on real-world data. Pharmacoeconomic 
      guidelines were applied, including probabilistic modelling and sensitivity 
      analyses. Results Compared with optimal medical treatment, on average 1.31 
      quality-adjusted life-years (QALY) are gained with CRT-P at an additional cost of 
      euro14 700, resulting in an incremental cost-effectiveness ratio (ICER) of about 
      euro11 200/QALY. As compared with CRT-P, CRT-D treatment adds on average an 
      additional 0.55 QALYs at an extra cost of euro30 900 resulting in an ICER of 
      euro57 000/QALY. This result was very sensitive to the incremental clinical benefit 
      of the defibrillator function on top of CRT. Conclusions Based on efficiency 
      arguments, CRT-P can be recommended for NYHA class III and IV patients if there 
      is a willingness to pay more than euro11 000/QALY. Even though CRT-D may offer a 
      survival benefit over CRT-P, the incremental clinical benefit appears to be too 
      marginal to warrant a threefold-higher device price for CRT-D. Further clinical 
      research should focus on the added value of CRT-D over CRT-P.
FAU - Neyt, Mattias
AU  - Neyt M
AD  - Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
FAU - Stroobandt, Serge
AU  - Stroobandt S
FAU - Obyn, Caroline
AU  - Obyn C
FAU - Camberlin, Cecile
AU  - Camberlin C
FAU - Devriese, Stephan
AU  - Devriese S
FAU - De Laet, Chris
AU  - De Laet C
FAU - Van Brabandt, Hans
AU  - Van Brabandt H
LA  - eng
PT  - Journal Article
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
PMC - PMC3211050
COIS- Competing interests: None.
EDAT- 2011/10/25 06:00
MHDA- 2011/10/25 06:01
PMCR- 2011/10/20
CRDT- 2011/10/25 06:00
PHST- 2011/10/25 06:00 [entrez]
PHST- 2011/10/25 06:00 [pubmed]
PHST- 2011/10/25 06:01 [medline]
PHST- 2011/10/20 00:00 [pmc-release]
AID - bmjopen-2011-000276 [pii]
AID - 10.1136/bmjopen-2011-000276 [doi]
PST - ppublish
SO  - BMJ Open. 2011 Jan 1;1(2):e000276. doi: 10.1136/bmjopen-2011-000276.