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Cost‐effectiveness of a cardiac contractility modulation device in heart failure with normal QRS duration
- Source :
- ESC Heart Failure, Vol 6, Iss 6, Pp 1178-1187 (2019), ESC Heart Failure
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- AIMS: The objective of this paper is to assess whether cardiac contractility modulation (via the Optimizer System) plus standard of care (SoC) is a cost-effective treatment for people with heart failure [New York Heart Association (NYHA) III, left ventricular ejection fraction of 25-45%, and narrow QRS] compared against SoC alone from the perspective of the English National Health Service. METHODS AND RESULTS: We developed a regression equation-based cost-effectiveness model, using individual patient data from three randomized control trials (FIX-HF-5 Phases 1 and 2, and FIX-HF-5C) to populate the majority of parameters. A series of regression equations predicted NYHA class over time, mortality, all-cause hospitalization rates, and health-related quality of life. We conducted the analysis in line with the National Institute for Health and Care Excellence reference case, modelling costs from an English National Health Service perspective, and considering outcomes in quality-adjusted life years (QALYs) over a patient lifetime perspective. Our base case analysis produced an incremental cost per additional QALY of GBP22 988 (€25 750) when comparing Optimizer + SoC to SoC alone. This result was not sensitive to parameter uncertainty but was sensitive to the time horizon over which costs and QALYs were captured and the duration over which a survival benefit with Optimizer + SoC can be assumed to apply. CONCLUSIONS: Cardiac contractility modulation is likely to be cost-effective in people with heart failure with reduced ejection fraction, NYHA III, and narrow QRS, provided that the treatment benefit can be maintained beyond the duration of the existing clinical trial follow-up. This analysis supports the current recommendations of the European Society of Cardiology that this therapy may be considered for such patients. peerReviewed
- Subjects :
- Male
Pacemaker, Artificial
lcsh:Diseases of the circulatory (Cardiovascular) system
Cardiac & Cardiovascular Systems
Cost effectiveness
Cost-Benefit Analysis
030204 cardiovascular system & hematology
Cardiac contractility modulation
law.invention
Electrocardiography
0302 clinical medicine
Randomized controlled trial
Quality of life
law
Original Research Articles
Original Research Article
030212 general & internal medicine
1102 Cardiorespiratory Medicine and Haematology
Randomized Controlled Trials as Topic
Ejection fraction
Heart
Cost-effectiveness analysis
Middle Aged
RESYNCHRONIZATION THERAPY
3. Good health
Hospitalization
SAFETY
Cardiology
Female
Cardiology and Cardiovascular Medicine
Life Sciences & Biomedicine
medicine.medical_specialty
Cost‐effectiveness analysis
Electric Stimulation Therapy
Heart failure
03 medical and health sciences
QRS complex
Internal medicine
medicine
Humans
Aged
ELECTRICAL IMPULSES
Science & Technology
business.industry
EFFICACY
medicine.disease
lcsh:RC666-701
Quality of Life
Cardiovascular System & Cardiology
business
Subjects
Details
- ISSN :
- 20555822
- Volume :
- 6
- Database :
- OpenAIRE
- Journal :
- ESC Heart Failure
- Accession number :
- edsair.doi.dedup.....a6b45b3f2b31eb97900bb34462e2958c