PMID- 30092774
OWN - NLM
STAT- MEDLINE
DCOM- 20190610
LR  - 20190613
IS  - 1471-2261 (Electronic)
IS  - 1471-2261 (Linking)
VI  - 18
IP  - 1
DP  - 2018 Aug 9
TI  - An early analysis of cost-utility of baroreflex activation therapy in advanced 
      chronic heart failure in Germany.
PG  - 163
LID - 10.1186/s12872-018-0898-x [doi]
LID - 163
AB  - BACKGROUND: This study aimed to evaluate cost-utility of baroreflex activation 
      therapy (BAT) using the Barostim neo device (CVRx Inc., Minneapolis, MN, USA) 
      compared with optimized medical management in patients with advanced chronic 
      heart failure (NYHA class III) who were not eligible for treatment with cardiac 
      resynchronization therapy, from a statutory health insurance perspective in 
      Germany over a lifetime horizon. METHODS: A decision analytic model was developed 
      using the combination of a decision tree and the Markov process. The model 
      included transitions between New York Heart Association (NYHA) health states, 
      each of which is associated with a risk of mortality, hospitalization, cost, and 
      quality of life. The effectiveness of BAT was projected through relative risks 
      for mortality (obtained by application of patient-level data to the Meta-analysis 
      Global Group in Chronic Heart Failure risk prediction model) and hospitalization 
      owing to worsening of heart failure (obtained from BAT Randomized Clinical 
      Trial). All patients were in NYHA class III at baseline. RESULTS: BAT led to an 
      incremental cost of euro33,185 (95% credible interval [CI] euro24,561-38,637) and 
      incremental benefits of 1.78 [95% CI 0.45-2.71] life-years and 1.19 [95% CI 
      0.30-1.81] quality-adjusted life-years (QALYs). This resulted in an incremental 
      cost-effectiveness ratio of euro27,951/QALY (95% CI euro21,357-82,970). BAT had a 59% 
      probability of being cost-effective at a willingness-to-pay threshold of 
      euro35,000/QALY (but 84% at a threshold of euro52,000/QALY). CONCLUSIONS: BAT can be 
      cost-effective in European settings in those not eligible for cardiac 
      resynchronization therapy among patients with advanced heart failure.
FAU - Borisenko, Oleg
AU  - Borisenko O
AUID- ORCID: 0000-0002-1361-2431
AD  - Synergus AB, Danderyd (Stockholm), Sweden. oleg.borisenko@synergus.com.
FAU - Muller-Ehmsen, Jochen
AU  - Muller-Ehmsen J
AD  - Department of Internal Medicine 3, Asklepios Klinik Altona, Hamburg, Germany.
FAU - Lindenfeld, JoAnn
AU  - Lindenfeld J
AD  - Heart Failure and Transplantation Section Vanderbilt Heart and Vascular Institute 
      Medical Center, Nashville, TN, USA.
FAU - Rafflenbeul, Erik
AU  - Rafflenbeul E
AD  - Department of Internal Medicine 1, Asklepios Klinik Barmbek, Hamburg, Germany.
FAU - Hamm, Christian
AU  - Hamm C
AD  - Kerckhoff Heart and Thoraxcenter, Bad Nauheim and Medical Clinic I, University of 
      Giessen, Giessen, Germany.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180809
PL  - England
TA  - BMC Cardiovasc Disord
JT  - BMC cardiovascular disorders
JID - 100968539
SB  - IM
MH  - *Baroreflex
MH  - Chronic Disease
MH  - Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Decision Trees
MH  - Disease Progression
MH  - Electric Stimulation Therapy/adverse effects/*economics/instrumentation
MH  - Germany
MH  - *Health Care Costs
MH  - Heart Failure/diagnosis/*economics/physiopathology/*therapy
MH  - Humans
MH  - Implantable Neurostimulators/*economics
MH  - Markov Chains
MH  - Models, Economic
MH  - Pressoreceptors/*physiopathology
MH  - Quality of Life
MH  - Quality-Adjusted Life Years
MH  - Recovery of Function
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC6085633
OTO - NOTNLM
OT  - Baroreflex activation therapy
OT  - Barostim
OT  - Cost-utility
OT  - Germany
OT  - Health economics
OT  - Markov modeling
COIS- Clinical data were obtained by the manufacturer (CVRx Inc., Minneapolis, MN, USA) 
      with patient consent and after ethical approval. For the aims of present study, 
      no further ethical approval was required, because the data were supplied by the 
      manufacturer in an anonymous form. Not applicable. OB is the employee of the 
      medical consulting company Synergus AB, which received a grant from CVRx Inc. to 
      develop a decision analytic model. JME has received speaker honoraria from CVRx 
      Inc. JL provided paid consulting support to CVRx Inc. CH is the member of the 
      Advisory Board to CVRx Inc. and has received speaker honoraria from CVRx Inc. ER 
      does not have any conflict of interest to report. Springer Nature remains neutral 
      with regard to jurisdictional claims in published maps and institutional 
      affiliations.
EDAT- 2018/08/11 06:00
MHDA- 2019/06/14 06:00
PMCR- 2018/08/09
CRDT- 2018/08/11 06:00
PHST- 2017/04/18 00:00 [received]
PHST- 2018/07/25 00:00 [accepted]
PHST- 2018/08/11 06:00 [entrez]
PHST- 2018/08/11 06:00 [pubmed]
PHST- 2019/06/14 06:00 [medline]
PHST- 2018/08/09 00:00 [pmc-release]
AID - 10.1186/s12872-018-0898-x [pii]
AID - 898 [pii]
AID - 10.1186/s12872-018-0898-x [doi]
PST - epublish
SO  - BMC Cardiovasc Disord. 2018 Aug 9;18(1):163. doi: 10.1186/s12872-018-0898-x.