Cost-effectiveness of implantable cardiac devices in patients with systolic heart failure

Mealing, S., Woods, B., Hawkins, N. , Cowie, M. R., Plummer, C. J., Abraham, W. T., Beshai, J. F., Klein, H. and Sculpher, M. (2016) Cost-effectiveness of implantable cardiac devices in patients with systolic heart failure. Heart, 102(21), pp. 1742-1749. (doi: 10.1136/heartjnl-2015-308883) (PMID:27411837)

Abstract

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 £30 000 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 £20 000 per QALY gained. Results were robust to altering key model parameters. Conclusions At a threshold of £30 000 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.

• Item Type: Articles
• Additional Information: his work was supported by Biotronik, Boston Scientific, Medtronic, Sorin and St. Jude Medical. MRC’s salary is funded by the National Institute for Health Research Cardiovascular Biomedical Research Unit at the Royal Brompton Hospital, London. CJP’s salary is funded by Newcastle upon Tyne Hospitals NHS Foundation Trust
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Hawkins, Professor Neil
• Authors: Mealing, S., Woods, B., Hawkins, N., Cowie, M. R., Plummer, C. J., Abraham, W. T., Beshai, J. F., Klein, H., and Sculpher, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Heart
• Publisher: BMJ Publishing Group
• ISSN: 1355-6037
• ISSN (Online): 1468-201X
• Published Online: 13 July 2016
• Copyright Holders: Copyright © 2016 Mealing S, et al.
• First Published: First published i Heart 102(21):1742-1749
• Publisher Policy: Reproduced under a Creative Commons License