Abstract 11299: Economic Impact and Cost-Effectiveness of Cardiac Resynchronization Therapy versus Optimal Medical Therapy in Mild Heart Failure: Long-Term Follow-Up and Projections From REVERSE
BACKGROUND: The REVERSE Study, a prospective double-blinded randomized trial, assessed whether or not Cardiac Resynchronization Therapy (CRT) together with Optimal Medical Therapy (OMT) limited the progression of Heart Failure (HF) compared to OMT alone in Class I/II HF subjects with QRS ≥120 ms and LVEF ≤40%. Patients were implanted with CRT (either with pacing capabilities only “CRT-P”, or combined with a defibrillator “CRT-D”) and randomized to CRT-ON or CRT-OFF. CRT-OFF patients were unblinded after 12 (US/Canada) or 24 months (Europe) and crossed-over to CRT-ON with pre-planned follow-up for 5 years. Our analysis investigates the cost-effectiveness of CRT in this cohort.
METHODS: Outcomes were modeled using regression-based techniques informed by actual 5 year data; Cost-Effectiveness for both CRT-ON vs. CRT-OFF and CRT-D vs. CRT-P were assessed. Co-variables used in all analyses were QRS Duration, Ischemic Etiology, LBBB, Gender and Age. NYHA Class based mortality as well as advanced statistical methods of cross-over adjustment were used to predict long-term outcomes in patients originally randomized to CRT-OFF. Costs were based on National Medicare Rates and analyses in the PREMIER US Hospital Database. Utility weights were sourced from literature. Separate analyses were performed for each covariate. The base-case time horizon was 10 years and results were also obtained for lifetime.
RESULTS: The Incremental Cost-Effectiveness Ratio (ICER) for CRT-ON vs.CRT-OFF was $18,275 per QALY gained. Results were robust to the inclusion of all covariates (maximum observation $40,437 per QALY). All-patient base-case of CRT-D vs. CRT-P was $16,587 per QALY gained. Isolating LBBB Patients yielded $22,086 per QALY in ON vs. OFF.
CONCLUSIONS: CRT is highly cost-effective in patients with Mild HF, QRS ≥120 ms and LV Systolic Dysfunction. These findings remain robust across all analyses and subgroups. Regardless of subgroup, CRT-D is highly cost-effective vs. CRT-P.
- © 2013 by American Heart Association, Inc.