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COST-EFFECTIVENESS OF CARDIAC RESYNCHRONIZATION THERAPY: PERSPECTIVE FROM ARGENTINA

Published online by Cambridge University Press:  24 September 2012

Rosana Poggio ,
Federico Augustovsky ,
Joaquín Caporale ,
Vilma Irazola  and
Santiago Miriuka
Rosana Poggio
Affiliation:
Institute for Clinical Effectiveness and Health Policy (IECS); Department of Cardiology, FLENI Foundation email: [email protected]
Federico Augustovsky
Affiliation:
Institute for Clinical Effectiveness and Health Policy (IECS)
Joaquín Caporale
Affiliation:
Institute for Clinical Effectiveness and Health Policy (IECS)
Vilma Irazola
Affiliation:
Institute for Clinical Effectiveness and Health Policy (IECS)
Santiago Miriuka
Affiliation:
Department of Cardiology, FLENI Foundation; CONICET
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Abstract

Objectives: Cardiac resynchronization therapy (CRT) has recently been shown to reduce both mid-term and long-term mortality in patients with mild heart failure. Although proven effective, it is unclear whether CRT is cost-effective in low and middle-income countries (LMIC). Therefore, we set out to analyze the cost-effectiveness of CRT in Argentina in patients with New York Heart Association (NYHA) functional class (FC) I or II heart failure (HF). We chose to compare patients receiving optimal medical treatment (OMT) and CRT with those patients receiving only OMT.

Methods: We constructed a Markov model with a cohort simulation, and a life-time horizon to assess costs, life-years, and quality-adjusted life-year (QALY) gained as a result of treatment with both CRT and OMT from an Argentine third party payer perspective. We included patients who met the following criteria: left ventricular ejection fraction (LVEF) ≤ 40 percent, sinus rhythm with a QRS ≥ 120 msec, and NYHA FC I-II HF. The results were expressed as cost per life-year and QALY gained in international dollars (ID$) for the year 2009.

Results: For the base case analysis performed, we started at a fixed age of 65. After applying a 3 percent annual discount rate, the incremental cost-effectiveness ratio (ICER) was 38.005 ID$ per year of life gained and 34.185 ID$ per QALY gained.

Conclusions: Long-term treatment with CRT appears to be cost-effective in Argentina compared with patients treated solely with OMT. Similar analysis should be performed to determine if this treatment option is cost-effective in other LMIC.

Keywords

Cost-effectivenessCardiac resynchronization therapyMarkov modelQuality-adjusted life yearsHeart failure
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 4 , October 2012 , pp. 429 - 435
Copyright
Copyright © Cambridge University Press 2012

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