PMID- 28254126
OWN - NLM
STAT- MEDLINE
DCOM- 20180105
LR  - 20181016
IS  - 2213-1787 (Electronic)
IS  - 2213-1779 (Linking)
VI  - 5
IP  - 3
DP  - 2017 Mar
TI  - Economic Value and Cost-Effectiveness of Cardiac Resynchronization Therapy Among 
      Patients With Mild Heart Failure: Projections From the REVERSE Long-Term 
      Follow-Up.
PG  - 204-212
LID - S2213-1779(16)30572-8 [pii]
LID - 10.1016/j.jchf.2016.10.014 [doi]
AB  - OBJECTIVES: This study investigated the cost effectiveness of early cardiac 
      resynchronization therapy (CRT) implantation among patients with mild heart 
      failure (HF). The differential cost effectiveness between CRT using a 
      defibrillator (CRT-Ds) and CRT using a pacemaker (CRT-P) was also assessed. 
      BACKGROUND: Cardiac resynchronization has been shown to be cost effective in New 
      York Heart Association (NYHA) functional classes III/IV but is less studied in 
      class II HF. The incremental costs of early CRT implementation in mild 
      HF compared with the costs potentially avoided because of delaying disease 
      progression to advanced HF are also unknown. Finally, combined biventricular 
      pacing and defibrillator (CRT-D) devices are more expensive than biventricular 
      pacemakers (CRT-P), but the relative cost effectiveness is controversial. 
      METHODS: Data from the 5-year follow-up phase of REVERSE (REsynchronization 
      reVErses Remodeling in Systolic Left vEntricular Dysfunction) were used. The 
      economics were evaluated from the U.S. Medicare perspective based on published 
      clinical projections. RESULTS: Probabilistic estimates yielded 
      $8,840/quality-adjusted life year (QALY) gained (95% confidence interval [CI]: 
      $6,705 to $10,804/QALY gained) for CRT-ON versus CRT-OFF (i.e., programmed "ON" 
      or "OFF" at pre-specified post-implantation timings) and $43,678/QALY gained for 
      CRT-D versus CRT-P (95% CI: $35,164 to $53,589/QALY gained) over the patient's 
      lifetime. Results were robust to choice of patient subgroup and alterations of 
      +/-10% to key model parameters. An "early" CRT-D class II strategy totaled $95,292 
      compared with $91,511 for a "late" implantation. An "early" implant offered on 
      average 1.00 year of additional survival for $3,781, resulting in an ICER of 
      $3,795/LY gained. CONCLUSIONS: This study demonstrates CRT cost effectiveness in 
      mild HF. The incremental CRT-D costs are justified by the anticipated benefits, 
      despite increased procurement costs and shorter generator longevities. 
      "Early" CRT-D implants have essential cost parity with "late" implants while 
      increasing the patient's survival. (REsynchronization reVErses Remodeling in 
      Systolic Left vEntricular Dysfunction [REVERSE]; NCT00271154).
CI  - Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Gold, Michael R
AU  - Gold MR
AD  - Division of Cardiology, Medical University of South Carolina, Charleston, South 
      Carolina. Electronic address: goldmr@musc.edu.
FAU - Padhiar, Amie
AU  - Padhiar A
AD  - ICON/Oxford Outcomes, Oxford, United Kingdom.
FAU - Mealing, Stuart
AU  - Mealing S
AD  - ICON/Oxford Outcomes, Oxford, United Kingdom.
FAU - Sidhu, Manpreet K
AU  - Sidhu MK
AD  - ICON/Oxford Outcomes, Morristown, New Jersey.
FAU - Tsintzos, Stelios I
AU  - Tsintzos SI
AD  - Medtronic Global Cardiac Rhythm and Heart Failure Headquarters, Global Health 
      Economics, Reimbursement and Outcomes Research, Mounds View, Minnesota.
FAU - Abraham, William T
AU  - Abraham WT
AD  - Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio.
LA  - eng
SI  - ClinicalTrials.gov/NCT00271154
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170111
PL  - United States
TA  - JACC Heart Fail
JT  - JACC. Heart failure
JID - 101598241
SB  - IM
CIN - JACC Heart Fail. 2017 Mar;5(3):213-215. PMID: 28254127
MH  - Cardiac Resynchronization Therapy/economics/*methods
MH  - Cardiac Resynchronization Therapy Devices/economics
MH  - Cost-Benefit Analysis
MH  - Defibrillators, Implantable/economics
MH  - Heart Failure/economics/*therapy
MH  - Humans
MH  - Medicare
MH  - Middle Aged
MH  - *Quality-Adjusted Life Years
MH  - Severity of Illness Index
MH  - United States
OTO - NOTNLM
OT  - cardiac resynchronization therapy
OT  - cost effectiveness
OT  - health economics
OT  - health policy
OT  - heart failure
EDAT- 2017/03/04 06:00
MHDA- 2018/01/06 06:00
CRDT- 2017/03/04 06:00
PHST- 2016/03/14 00:00 [received]
PHST- 2016/09/23 00:00 [revised]
PHST- 2016/10/27 00:00 [accepted]
PHST- 2017/03/04 06:00 [entrez]
PHST- 2017/03/04 06:00 [pubmed]
PHST- 2018/01/06 06:00 [medline]
AID - S2213-1779(16)30572-8 [pii]
AID - 10.1016/j.jchf.2016.10.014 [doi]
PST - ppublish
SO  - JACC Heart Fail. 2017 Mar;5(3):204-212. doi: 10.1016/j.jchf.2016.10.014. Epub 
      2017 Jan 11.