PMD50 Cost-Effectiveness of Cardiac resynchronisation therapy for Patients with Moderate-to-Severe Heart Failure

To assess the cost-effectiveness of cardiac resynchronisation therapy (CRT) both with CRT-P (biventricular pacemaker only) and CRT-D (biventricular pacemaker with defibrillator) in patients with New York Heart Association (NYHA) functional class III/IV from a Belgian health care payer perspective. A lifetime Markov model was designed to calculate the cost-utility of both interventions. In the reference case, the treatment effect is based on the COMPANION trial. Costs are based on real-world data. Pharmacoeconomic guidelines were applied, including probabilistic modelling and sensitivity analyses. Compared with optimal medical treatment, on average 1.31 quality-adjusted life-years (QALY) are gained with CRT-P at an additional cost of €14,700, resulting in an incremental cost-effectiveness ratio (ICER) of about €11,200/QALY. As compared to CRT-P, CRT-D treatment adds on average an additional 0.55 QALYs at an extra cost of €30,900 resulting in an ICER of €57,000/QALY. This result was very sensitive to the incremental clinical benefit of the defibrillator function on top of CRT. Based on efficiency arguments, CRT-P can be recommended for NYHA class III and IV patients if there is a willingness to pay more than €11,000/QALY. Even though CRT-D may offer a survival benefit over CRT-P, the incremental clinical benefit appears to be too marginal to warrant a three times higher device price for CRT-D. Further clinical research should focus on the added value of CRT-D over CRT-P.