Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure.

BACKGROUND Heart failure is a common, costly, and debilitating illness. Resynchronization of ventricular contraction in patients with heart failure improves ejection fraction. The long-term morbidity and costs associated with such cardiac resynchronization therapy remain unclear. OBJECTIVE To assess the incremental cost-effectiveness of cardiac resynchronization therapy. DESIGN Markov model with Monte Carlo simulation. Future costs and effects were discounted at 3%. DATA SOURCES Effects data were obtained from a concurrent systematic review. Health-related quality-of-life and cost data were obtained from publicly available data or from surveys. TARGET POPULATION Patients with reduced ventricular function and prolonged QRS. TIME HORIZON Lifetime. PERSPECTIVE U.S. health care system. INTERVENTIONS Cardiac resynchronization therapy versus medical therapy. OUTCOME MEASURES Quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS Medical therapy yielded a median of 2.64 (interquartile range, 2.47 to 2.82) discounted QALYs and a median discounted lifetime cost of 34,400 dollars (interquartile range, 31,100 dollars to 37,700 dollars). Cardiac resynchronization therapy was associated with a median incremental cost of 107,800 dollars(interquartile range, 79,800 dollars to 156,500 dollars) per additional QALY. RESULTS OF SENSITIVITY ANALYSIS Results were sensitive to changes in several variables, including the relative risk for death or hospitalization. LIMITATIONS These results apply to patients who meet the inclusion criteria of the currently completed trials. CONCLUSIONS The incremental cost per QALY for cardiac resynchronization is similar to that of other commonly used interventions but is sensitive to changes in several key variables. Resynchronization therapy should not be considered in patients with comorbid illness that shortens life expectancy.