PMID- 26301323
OWN - NLM
STAT- MEDLINE
DCOM- 20151214
LR  - 20210511
IS  - 1539-3704 (Electronic)
IS  - 0003-4819 (Print)
IS  - 0003-4819 (Linking)
VI  - 163
IP  - 6
DP  - 2015 Sep 15
TI  - Cost-Effectiveness of Adding Cardiac Resynchronization Therapy to an Implantable 
      Cardioverter-Defibrillator Among Patients With Mild Heart Failure.
PG  - 417-26
LID - 10.7326/M14-1804 [doi]
AB  - BACKGROUND: Cardiac resynchronization therapy (CRT) reduces mortality and heart 
      failure hospitalizations in patients with mild heart failure. OBJECTIVE: To 
      estimate the cost-effectiveness of adding CRT to an implantable 
      cardioverter-defibrillator (CRT-D) compared with implantable 
      cardioverter-defibrillator (ICD) alone among patients with left ventricular 
      systolic dysfunction, prolonged intraventricular conduction, and mild heart 
      failure. DESIGN: Markov decision model. DATA SOURCES: Clinical trials, clinical 
      registries, claims data from Centers for Medicare & Medicaid Services, and 
      Centers for Disease Control and Prevention life tables. TARGET POPULATION: 
      Patients aged 65 years or older with a left ventricular ejection fraction (LVEF) 
      of 30% or less, QRS duration of 120 milliseconds or more, and New York Heart 
      Association (NYHA) class I or II symptoms. TIME HORIZON: Lifetime. PERSPECTIVE: 
      Societal. INTERVENTION: CRT-D or ICD alone. OUTCOME MEASURES: Life-years, 
      quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness 
      ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: Use of CRT-D increased life 
      expectancy (9.8 years versus 8.8 years), QALYs (8.6 years versus 7.6 years), and 
      costs ($286 500 versus $228 600), yielding a cost per QALY gained of $61 700. 
      RESULTS OF SENSITIVITY ANALYSES: The cost-effectiveness of CRT-D was most 
      dependent on the degree of mortality reduction: When the risk ratio for death was 
      0.95, the ICER increased to $119 600 per QALY. More expensive CRT-D devices, 
      shorter CRT-D battery life, and older age also made the cost-effectiveness of 
      CRT-D less favorable. LIMITATIONS: The estimated mortality reduction for CRT-D 
      was largely based on a single trial. Data on patients with NYHA class I symptoms 
      were limited. The cost-effectiveness of CRT-D in patients with NYHA class I 
      symptoms remains uncertain. CONCLUSION: In patients with an LVEF of 30% or less, 
      QRS duration of 120 milliseconds or more, and NYHA class II symptoms, CRT-D 
      appears to be economically attractive relative to ICD alone when a reduction in 
      mortality is expected. PRIMARY FUNDING SOURCE: National Institutes of Health, 
      University of Copenhagen, U.S. Department of Veterans Affairs.
FAU - Woo, Christopher Y
AU  - Woo CY
FAU - Strandberg, Erika J
AU  - Strandberg EJ
FAU - Schmiegelow, Michelle D
AU  - Schmiegelow MD
FAU - Pitt, Allison L
AU  - Pitt AL
FAU - Hlatky, Mark A
AU  - Hlatky MA
FAU - Owens, Douglas K
AU  - Owens DK
FAU - Goldhaber-Fiebert, Jeremy D
AU  - Goldhaber-Fiebert JD
LA  - eng
GR  - K01 AG037593/AG/NIA NIH HHS/United States
GR  - KL2 TR001083/TR/NCATS NIH HHS/United States
GR  - T15 LM007033/LM/NLM NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Ann Intern Med
JT  - Annals of internal medicine
JID - 0372351
SB  - IM
CIN - Evid Based Med. 2016 Jun;21(3):88. PMID: 26887422
MH  - Aged
MH  - Cardiac Resynchronization Therapy/adverse effects/*economics
MH  - Combined Modality Therapy
MH  - *Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Defibrillators, Implantable/adverse effects/*economics
MH  - Electrocardiography
MH  - Heart Failure/mortality/physiopathology/*therapy
MH  - Humans
MH  - Quality-Adjusted Life Years
MH  - Sensitivity and Specificity
MH  - Ventricular Dysfunction, Left/physiopathology
PMC - PMC8105088
MID - NIHMS1694592
EDAT- 2015/08/25 06:00
MHDA- 2015/12/15 06:00
PMCR- 2021/05/07
CRDT- 2015/08/25 06:00
PHST- 2015/08/25 06:00 [entrez]
PHST- 2015/08/25 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
PHST- 2021/05/07 00:00 [pmc-release]
AID - 2430208 [pii]
AID - 10.7326/M14-1804 [doi]
PST - ppublish
SO  - Ann Intern Med. 2015 Sep 15;163(6):417-26. doi: 10.7326/M14-1804.