Is combined resynchronisation and implantable defibrillator therapy a cost-effective option for left ventricular dysfunction?

Bond, M., Mealing, S., Anderson, R., Dean, J., Stein, K. and Taylor, R. S. (2008) Is combined resynchronisation and implantable defibrillator therapy a cost-effective option for left ventricular dysfunction? International Journal of Cardiology, 137(3), pp. 206-215. (doi: 10.1016/j.ijcard.2008.05.073) (PMID:18703244)

Abstract

Objective: To evaluate the cost-effectiveness of combined resynchronisation and implantable defibrillator therapy for left ventricular dysfunction and explore subgroups in which such devices might be most cost-effective. Design: Markov model-based economic evaluation. Setting: UK NHS. Participants: A simulated mixed age cohort of NYHA class III and IV patients with left ventricular systolic dysfunction and prolonged QRS interval. Main outcome measures: Cost per quality adjusted life year gained over the patient lifetime. Results: The incremental cost-effectiveness of resynchronisation therapy alone compared with optimal medical therapy was £16,735 (95% CI: £14,630 to £20,333) with a 91% probability of being cost-effective at a willingness to pay threshold of £30,000. Compared with resynchronisation alone, the incremental cost-effectiveness of combined implantable defibrillator was £40,160 (95% CI: £26,645 to £59,391) with only a 26% probability of cost-effectiveness at the £30,000 threshold. In a direct comparison across three treatments (medical treatment, resynchronisation alone and combined resynchronisation with implantable defibrillator therapy) resynchronisation alone was found to be the most cost-effective option. Conclusion: Combined resynchronisation and implantable defibrillator therapy is not cost-effective for left ventricular dysfunction. Instead resynchronisation alone remains the most cost-effective policy option in this population. Combined devices are more likely to be cost-effective in the subgroups of younger patients or those with high risk of sudden cardiac death who would qualify for resynchronisation therapy.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Taylor, Professor Rod
• Authors: Bond, M., Mealing, S., Anderson, R., Dean, J., Stein, K., and Taylor, R. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: International Journal of Cardiology
• ISSN: 0167-5273
• ISSN (Online): 1874-1754