Cardiac Resynchronization Therapy Shown to be Cost-Effective
December 3, 2010 – For the first time, data has shown that cardiac resynchronization therapy (CRT) is cost-effective in mildly symptomatic heart failure (HF) patients. Data from an economic sub-study of the REVERSE trial was published in the European Heart Journal.
The results showed a €14,278 per quality adjusted life years (QALY) gained for CRT, compared to the commonly used European willingness to pay (WTP) threshold of €33,000 per QALY gained. Additionally, patients receiving CRT are estimated to gain almost one full year (0.94) or 0.80 QALYs compared to the group not receiving CRT, at an additional cost of €11,455, over ten years.
"While prior studies have proven the numerous benefits and cost-effectiveness of CRT in treating symptomatic heart failure patients, now for the first time, these data show that CRT not only helps keep less sick heart failure patients out of the hospital more, but it is also a more cost-effective treatment approach than many other therapeutic options currently available,” said Cecilia Linde, M.D., Ph.D., Karolinska University, Stockholm, Sweden. “We look forward to conducting additional analyses demonstrating the economic value of this treatment approach in a mildly symptomatic patient population.”
An economic model was developed to predict the effect of CRT on life years, QALYs and costs over time periods up to 10 years. The economic analysis was based on clinical data that showed at 24 months a worsening of heart failure in 34 percent of patients who did not have CRT therapy, compared with 19 percent of patients who did. Additionally, the time to first heart failure hospitalization was significantly longer in the CRT-on than the CRT-off group (hazard ratio = 0.39, p < 0.01).
CRT uses a stopwatch-sized implantable device to resynchronize the contractions of the ventricles by sending tiny electrical impulses to the heart muscle. Resynchronizing the contractions of the ventricles may help the heart pump blood throughout the body more efficiently and reduce symptoms.
The trial did not meet statistical significance for its primary endpoint (percent of patients worsened at 12 months). However, patients experienced a significant improvement in cardiac function and reduction in HF hospitalizations. Furthermore, the European sub-group, which was followed through 24 months, demonstrated statistical significance for the same endpoint (19 percent versus 34 percent worsened in the CRT-on and -off groups, p = 0.01).
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