Modelling the economic and health consequences of cardiac resynchronization therapy in the UK

Objective: Clinical evidence supports the use of cardiac resynchronization therapy ( CRT) in advanced heart failure, but its cost-effectiveness is still unclear. This analysis assessed the economic and health consequences in the UK of implanting a CRT in patients with NYHA class III - IV heart failure. Methods: A discrete event simulation of heart failure was used to compare the course over 5 years of 1000 identical pairs of patients - one receiving both CRT and optimum pharmacologic treatment ( OPT), the other OPT alone. All inputs were obtained from the data collected in the CArdiac REsynchronization in Heart Failure ( CARE-HF) trial and a hospital in the UK. Direct medical costs ( in 2004 ) pound from the perspective of the National Health Service were considered. Both costs and benefits were discounted at 3.5%. Sensitivity analyses addressed all model inputs and multivariate analyses were performed by varying key parameters simultaneously. Results: The model predicted 471 deaths and 2263 hospitalizations over 5 years with OPT alone and 348 deaths and 1764 hospitalizations with CRT, equivalent to a 26% reduction in mortality and 22% in hospitalizations, at a discounted cost of pound 11 423 per patient with CRT vs. pound 4900 with OPT alone. CRT was predicted to increase quality-adjusted survival by 0.43 QALYs per patient, adjusted resulting in an incremental cost-effectiveness ratio of pound 15 247 per QALY gained ( range: pound 12 531 - pound 23 184). Sensitivity analyses revealed that this outcome was most sensitive to time horizon and cost of implantation. Conclusion: Based on these 5-year analyses, CRT is expected to yield substantial health benefits at a reasonable cost.