Abstract 16317: Cost-Effectiveness of Bi-Ventricular Pacemakers vs. RV Pacemakers and Bi-Ventricular Defibrillators vs. Dual Chamber Defibrillators in Patients With Atrioventricular Block and Systolic Dysfunction: All-Patient and Subgroup Analyses From the BLOCK-HF Clinical Trial
BACKGROUND: The cost-effectiveness (C-E) of biventricular (BiV) pacing compared to right ventricular (RV) pacing in patients with a pacing indication due to atrioventricular (AV) block and EF < 50% is unknown. Material differences may exist between the C-E of BiV pacemakers (BiV-P) vs. RV and BiV defibrillators (BiV-D) vs. dual chamber ICDs, the latter when patients independently have an ICD indication.
METHODS: Patient-level data from the BLOCK-HF trial were used. Statistical models were used to predict all-cause mortality, NYHA distribution over time, and NYHA-specific HF-related healthcare utilization (HCU) rates. Analyses were undertaken separately for BiV/RV (All-Patient), BiV-P/IPG and BiV-D/ICD.
RESULTS: HCU rates in NYHA Classes I/II were lower than Classes III/IV and consistently reduced with BiV devices. Predicted life expectancy in the “All-Patient” analysis was 6.78 years with RV devices and 7.52 with BiV ones (a 10.8% increase). More BiV patients were predicted to remain in, or improve to, Classes I/II, if alive. In the “All-Patient” analysis, BiV offered patients 0.41 more Quality-Adjusted Life Years (QALYs) compared to RV, at an additional cost of $12,537 (Incremental C-E Ratio “ICER” $30,860.16/QALY Gained). Within the clinical co-variate subgroups of the “All-Patient” analysis, the highest ICER observed was $43,687.59 (NYHA Class I Patients). Within the device-based subgroups, BiV-D patients were projected to benefit more (0.84 years gained) than BiV-P ones (0.49 years)
CONCLUSIONS: BiV reduces HCU rates compared with RV, offering survival benefits and slowing HF progression. The “All-Patient” ICER was $30,860.16/QALY Gained and ICERs were consistently below the conventional US acceptability threshold ($50,000/QALY Gained). The additional cost associated with offering BiV devices to patients with AV block and systolic dysfunction appears justified by the expected benefits across both device types.
Author Disclosures: P.B. Adamson: Honoraria; Modest; Medtronic, Inc., St. Jude Medical, Inc., Boston Scientific, Inc., CardioMEMS, Inc.. Consultant/Advisory Board; Modest; Medtronic, Inc., St. Jude Medical, Inc., CardioMEMS, Inc. E.S. Chung: Research Grant; Modest; Otsuka. Consultant/Advisory Board; Modest; Medtronic, Boston Scientific, Gambro, CardioMems. M.G. St. John Sutton: Consultant/Advisory Board; Modest; Medtronic, Inc., BioControl Medical. M.K. Sidhu: Employment; Significant; ICON plc. S. Mealing: Employment; Significant; ICON plc. A. Padhiar: Employment; Significant; ICON plc. S.I. Tsintzos: Employment; Significant; Medtronic, Inc. S.L. Bril: Employment; Significant; Medtronic, Inc. A.A. Lautenbach: Employment; Significant; Medtronic, Inc. A.B. Curtis: Honoraria; Modest; Biosense Webster, Inc., St. Jude Medical, Inc., Sanofi Aventis, Janssen Pharmaceuticals, Bristol Meyers Squibb, Pfizer, Inc., Daiichi Sankyo. Honoraria; Significant; Medtronic, Inc.. Other; Modest; Jones & Bartlett Publishers.
- © 2014 by American Heart Association, Inc.