Cost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial

Calvert, M.J., Freemantle, N., Yao, G., Cleland, J.G., Billingham, L., Daubert, J.C. and Bryan, S. (2005) Cost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial. European Heart Journal, 26 (24), 2681-2688. (doi:10.1093/eurheartj/ehi662). (PMID:16284203)

Abstract

Aims

Whilst the CArdiac REsynchronization in Heart Failure (CARE-HF) trial has shown that cardiac resynchronization therapy (CRT) leads to reduced morbidity and mortality, the cost-effectiveness of this therapy remains uncertain. The aim of this study was to evaluate the incremental cost per quality adjusted life year (QALY) gained and incremental cost per life year gained of CRT plus medical therapy compared to medical therapy alone.

Methods and results

This prospective analysis based on intention to treat data from all patients enrolled in the CARE-HF trial at 82 clinical centres in 12 European countries. A total of 813 patients with New York Heart Association class III or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony were randomized to CRT plus medical therapy (n=409) vs. medical therapy alone (n=404). During a mean follow-up of 29.4 months CRT was associated with increased costs (€4316, 95% CI: 1327–7485), survival (0.10 years, 95% CI: -0.01–0.21), and QALYs (0.22, 95% CI: 0.13–0.32). The incremental cost-effectiveness ratio was €19319 per QALY gained (95% CI: 5482–45402) and €43596 per life-year gained (95% CI: -146236–223849). These results were sensitive to the costs of the device, procedure, and hospitalization.

Conclusion

Treatment with CRT appears cost-effective at the notional willingness to pay threshold of €29400 (£20000) per QALY gained.

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