This article appears in the following Europace issue: Spotlight Issue: Cardiac Resynchronization Therapy [View the issue table of contents]
Is cardiac resynchronization therapy cost-effective?
Institute of Cardiology, University of Bologna and Azienda Ospedaliera S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
Cardiac resynchronization therapy (CRT) is a treatment of proven efficacy for selected patients with heart failure and associated conduction disturbances. The increasing financial burden that healthcare systems face has increased the interest in cost-effectiveness and cost-utility estimates, focused on devices with defibrillation capabilities (CRT-D), with a high upfront cost, as well as on simpler devices providing only biventricular pacing (CRT-P). Available economic estimates are largely dependent on data source, assumptions, modelling technique, time horizon, and perspective, leading to some variability in cost-effectiveness and cost-utility estimates. As a whole, cost-effectiveness and cost-utility estimates of both CRT-P and CRT-D improve as the time horizon examined is lengthened and appear to be below US$50 000 per quality-adjusted life-year, a threshold value commonly adopted for coverage of healthcare interventions in the USA and quite comparable with similar thresholds used within Europe. Limited data are available on the comparative cost-effectiveness or cost-utility of CRT-P and CRT-D devices. Moreover, more data on the effectiveness and long-term benefits of CRT-D and CRT-P are needed in order to estimate better the value of these treatments in the ‘real world, as well as for attempts to improve cost-effectiveness through improved patient selection.
Key Words: Cardiac resynchronization therapy, Cost, Cost-effectiveness, Cost-utility, Heart failure, Health economics
* Corresponding author. Tel: +39 051 349858, Fax: +39 051 344859, Email: giuseppe.boriani{at}unibo.it