A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

F. Tomini (), F. Prinzen and A. D. I. Asselt
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F. Tomini: Maastricht University Medical Centre
F. Prinzen: Cardiovascular Research Institute Maastricht (CARIM)
A. D. I. Asselt: University of Groningen

The European Journal of Health Economics, 2016, vol. 17, issue 9, No 9, 1159-1172

Abstract: Abstract Objectives Cardiac resynchronization therapy with a biventricular pacemaker (CRT-P) is an effective treatment for dyssynchronous heart failure (DHF). Adding an implantable cardioverter defibrillator (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, if the majority of patients do not require shock therapy, the cost-effectiveness ratio of CRT-D compared to CRT-P may be high. The objective of this study was to systematically review decision models evaluating the cost-effectiveness of CRT-D for patients with DHF, compare the structure and inputs of these models and identify the main factors influencing the ICERs for CRT-D. Methods A comprehensive search strategy of Medline (Ovid), Embase (Ovid) and EconLit identified eight cost-effectiveness models evaluating CRT-D against optimal pharmacological therapy (OPT) and/or CRT-P. Results The selected economic studies differed in terms of model structure, treatment path, time horizons, and sources of efficacy data. CRT-D was found cost-effective when compared to OPT but its cost-effectiveness became questionable when compared to CRT-P. Conclusions Cost-effectiveness of CRT-D may increase depending on improvement of all-cause mortality rates and HF mortality rates in patients who receive CRT-D, costs of the device, and battery life. In particular, future studies need to investigate longer-term mortality rates and identify CRT-P patients that will gain the most, in terms of life expectancy, from being treated with a CRT-D.

Keywords: Review; Cost-effectiveness; Cardiac resynchronization therapy; Cardiac pacing; Implantable cardioverter-defibrillator; Markov chains; Models; Economic; Heart failure; Sudden cardiac death (search for similar items in EconPapers)
JEL-codes: C63 D61 H43 I18 (search for similar items in EconPapers)
Date: 2016
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DOI: 10.1007/s10198-015-0752-3

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