PMID- 27411837 OWN - NLM STAT- MEDLINE DCOM- 20170717 LR - 20191210 IS - 1468-201X (Electronic) IS - 1355-6037 (Print) IS - 1355-6037 (Linking) VI - 102 IP - 21 DP - 2016 Nov 1 TI - Cost-effectiveness of implantable cardiac devices in patients with systolic heart failure. PG - 1742-1749 LID - 10.1136/heartjnl-2015-308883 [doi] AB - OBJECTIVE: To evaluate the cost-effectiveness of implantable cardioverter defibrillators (ICDs), cardiac resynchronisation therapy pacemakers (CRT-Ps) and combination therapy (CRT-D) in patients with heart failure with reduced ejection fraction based on a range of clinical characteristics. METHODS: Individual patient data from 13 randomised trials were used to inform a decision analytical model. A series of regression equations were used to predict baseline all-cause mortality, hospitalisation rates and health-related quality of life and device-related treatment effects. Clinical variables used in these equations were age, QRS duration, New York Heart Association (NYHA) class, ischaemic aetiology and left bundle branch block (LBBB). A UK National Health Service perspective and a lifetime time horizon were used. Benefits were expressed as quality-adjusted life-years (QALYs). Results were reported for 24 subgroups based on LBBB status, QRS duration and NYHA class. RESULTS: At a threshold of pound30 000 per QALY gained, CRT-D was cost-effective in 10 of the 24 subgroups including all LBBB morphology patients with NYHA I/II/III. ICD is cost-effective for all non-NYHA IV patients with QRS duration <120 ms and for NYHA I/II non-LBBB morphology patients with QRS duration between 120 ms and 149 ms. CRT-P was also cost-effective in all NYHA III/IV patients with QRS duration >120 ms. Device therapy is cost-effective in most patient groups with LBBB at a threshold of pound20 000 per QALY gained. Results were robust to altering key model parameters. CONCLUSIONS: At a threshold of pound30 000 per QALY gained, CRT-D is cost-effective in a far wider group than previously recommended in the UK. In some subgroups ICD and CRT-P remain the cost-effective choice. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. FAU - Mealing, Stuart AU - Mealing S AD - ICON Health Economics, ICON Clinical Research (UK) Ltd., Abingdon, UK. FAU - Woods, Beth AU - Woods B AD - Centre for Health Economics, University of York, York, UK. FAU - Hawkins, Neil AU - Hawkins N AD - ICON Health Economics, ICON Clinical Research (UK) Ltd., Abingdon, UK. FAU - Cowie, Martin R AU - Cowie MR AD - National Heart & Lung Institute, Imperial College London (Royal Brompton Hospital), London, UK. FAU - Plummer, Christopher J AU - Plummer CJ AD - Cardiothoracic Directorate, Freeman Hospital, Newcastle upon Tyne, UK. FAU - Abraham, William T AU - Abraham WT AD - Department of Internal Medicine, Ohio State University Medical Centre, Columbus, Ohio, USA. FAU - Beshai, John F AU - Beshai JF AD - Department of Cardiovascular Diseases Mayo Clinic, Phoenix, Arizona, USA. FAU - Klein, Helmut AU - Klein H AD - University of Rochester Medical Centre, University of Rochester, New York, USA. FAU - Sculpher, Mark AU - Sculpher M AD - ICON Health Economics, ICON Clinical Research (UK) Ltd., Abingdon, UK Centre for Health Economics, University of York, York, UK. LA - eng PT - Journal Article DEP - 20160713 PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 SB - IM MH - Aged MH - Cardiac Resynchronization Therapy/adverse effects/*economics/mortality MH - Cardiac Resynchronization Therapy Devices/*economics MH - Cost-Benefit Analysis MH - Decision Support Techniques MH - Defibrillators, Implantable/*economics MH - Electric Countershock/adverse effects/*economics/instrumentation/mortality MH - Female MH - *Health Care Costs MH - Heart Failure, Systolic/diagnosis/*economics/mortality/*therapy MH - Hospital Costs MH - Hospitalization/economics MH - Humans MH - Male MH - Models, Economic MH - Patient Selection MH - Process Assessment, Health Care/*economics MH - Quality-Adjusted Life Years MH - Randomized Controlled Trials as Topic MH - Time Factors MH - Treatment Outcome PMC - PMC5099208 COIS- BW, SM, and NH were employees of ICON during the period of this work. MS is a consultant to ICON. and received payment for his involvement in this work. MRC provides consultancy advice to Medtronic, Boston Scientific and St. Jude Medical and has had research grants from Medtronic. CJP has received research funding and travel grants to attend scientific meetings and has provided consultancy advice to Medtronic, Boston Scientific and St. Jude Medical. HK has provided consultancy advice and has received research funding from Boston Scientific. WA has received consulting fees from St. Jude Medical and Biotronik. EDAT- 2016/07/15 06:00 MHDA- 2017/07/18 06:00 PMCR- 2016/11/08 CRDT- 2016/07/15 06:00 PHST- 2015/10/26 00:00 [received] PHST- 2016/05/18 00:00 [accepted] PHST- 2016/07/15 06:00 [pubmed] PHST- 2017/07/18 06:00 [medline] PHST- 2016/07/15 06:00 [entrez] PHST- 2016/11/08 00:00 [pmc-release] AID - heartjnl-2015-308883 [pii] AID - 10.1136/heartjnl-2015-308883 [doi] PST - ppublish SO - Heart. 2016 Nov 1;102(21):1742-1749. doi: 10.1136/heartjnl-2015-308883. Epub 2016 Jul 13.