Objective: To evaluate the cost-effectiveness of implantable cardioverter-defibrillators (ICD), cardiac resynchronisation therapy pacemakers (CRT-P) and combination therapy (CRT-D) in patients with heart failure with reduced ejection fraction based on a range of clinical characteristics. Methods: Individual patient data from 13 randomised trials were used to inform a decision analytic model. A series of regression equations were used to predict baseline all-cause mortality, hospitalisation rates and health related quality of life (HRQoL) and device-related treatment effects. Clinical variables used in these equations were age, QRS duration, NYHA class, ischemic aetiology, and LBBB. A UK NHS perspective and a lifetime time horizon were used. Benefits were expressed as quality adjusted life years (QALYs). Results were reported for 24 subgroups based on LBBB status, QRS duration and NYHA class. Results: At a threshold of £30,000 per QALY gained, CRT-D was cost-effective in 10 of the 24 subgroups including all LBBB morphology patients with NYHA I/III/III. ICD is cost-effective for all non-NYHA IV patients with QRS duration <120ms and for NYHA I/II non-LBBB morphology patients with QRS duration between 120 and 149ms. CRT-P was also cost-effective in all NYHA III/IV patients with QRS duration >120ms. Device therapy is costeffective in most patient groups with LBBB at a threshold of £20,000 per QALY gained. Results were robust to altering key model parameters. Conclusions: At a threshold of £30,000 per QALY gained, CRT-D is cost-effective in a far wider group than previously recommended in the UK. In some subgroups ICD and CRT-P remain the cost-effective choice.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)