PMID- 32207659
OWN - NLM
STAT- MEDLINE
DCOM- 20210511
LR  - 20210511
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 23
IP  - 7
DP  - 2020 Jul
TI  - Cost-effectiveness analysis of implantable cardiac devices in patients with 
      systolic heart failure: a US perspective using real world data.
PG  - 690-697
LID - 10.1080/13696998.2020.1746316 [doi]
AB  - Aims: Heart failure with reduced ejection fraction (HFrEF) has a substantial 
      impact on costs and patients' quality-of-life. This study aimed to estimate the 
      cost-effectiveness of implantable cardioverter defibrillators (ICD), cardiac 
      resynchronization therapy pacemakers (CRT-P), cardiac resynchronization therapy 
      defibrillators (CRT-D), and optimal pharmacologic therapy (OPT) in patients with 
      HFrEF, from a US payer perspective.Materials and methods: The analyses were 
      conducted by adapting the UK-based cost-effectiveness analyses (CEA) to the US 
      payer perspective by incorporating real world evidence (RWE) on baseline 
      hospitalization risk and Medicare-specific costs. The CEA was based on regression 
      equations estimated from data from 13 randomized clinical trials (n = 12,638). 
      Risk equations were used to predict all-cause mortality, hospitalization rates, 
      health-related quality-of-life, and device-specific treatment effects (vs. OPT). 
      These equations included the following prognostic characteristics: age, QRS 
      duration, New York Heart Association (NYHA) class, ischemic etiology, and left 
      bundle branch block (LBBB). Baseline hospitalization rates were calibrated based 
      on RWE from Truven Health Analytics MarketScan data (2009-2014). A US payer 
      perspective, lifetime time horizon, and 3% discount rates for costs and outcomes 
      were used. Benefits were expressed as quality-adjusted life-years (QALYs). 
      Incremental cost-effectiveness analysis was conducted for 24 sub-groups based on 
      LBBB status, QRS duration, and NYHA class.Results: Results of the analyses show 
      that CRT-D was the most cost-effective treatment at a $100,000/QALY threshold in 
      14 of the 16 sub-groups for which it is indicated. Results were most sensitive to 
      changes in estimates of hospitalization costs.Limitations: Study limitations 
      include small sample sizes for NYHA I and IV sub-groups and lack of data 
      availability for duration of treatment effect.Conclusions: CRT-D has higher 
      greater cost-effectiveness across more sub-groups in the indicated patient 
      populations against as compared to OPT, ICD, and CRT-P, from a US payer 
      perspective.
FAU - Shah, Dhvani
AU  - Shah D
AUID- ORCID: 0000-0002-0287-337X
AD  - Value, Access and Outcomes, ICON plc, New York, NY, USA.
FAU - Lu, Xiaoxiao
AU  - Lu X
AD  - Economics, Reimbursement & Evidence, Medtronic plc, Mounds View, MN, USA.
FAU - Paly, Victoria F
AU  - Paly VF
AD  - Value, Access and Outcomes, ICON plc, New York, NY, USA.
FAU - Tsintzos, Stelios I
AU  - Tsintzos SI
AD  - Market Development, Medtronic plc, Tolochenaz, Switzerland.
FAU - May, Damian M
AU  - May DM
AD  - Economics, Reimbursement & Evidence, Medtronic plc, Mounds View, MN, USA.
LA  - eng
PT  - Journal Article
DEP - 20200414
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
SB  - IM
MH  - Aged
MH  - Cardiac Resynchronization Therapy Devices/*economics
MH  - *Cost-Benefit Analysis
MH  - Databases, Factual
MH  - Defibrillators, Implantable/*economics
MH  - Female
MH  - Health Care Costs
MH  - Heart Failure, Systolic/*drug therapy/*surgery
MH  - Humans
MH  - Male
MH  - Medicare
MH  - Middle Aged
MH  - Quality-Adjusted Life Years
MH  - Retrospective Studies
MH  - United States
OTO - NOTNLM
OT  - C10
OT  - C50
OT  - Heart failure
OT  - Medicare
OT  - US
OT  - cost-effectiveness
OT  - implantable cardiac devices
EDAT- 2020/03/25 06:00
MHDA- 2021/05/12 06:00
CRDT- 2020/03/25 06:00
PHST- 2020/03/25 06:00 [pubmed]
PHST- 2021/05/12 06:00 [medline]
PHST- 2020/03/25 06:00 [entrez]
AID - 10.1080/13696998.2020.1746316 [doi]
PST - ppublish
SO  - J Med Econ. 2020 Jul;23(7):690-697. doi: 10.1080/13696998.2020.1746316. Epub 2020 
      Apr 14.