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Modelling the economic and health consequences of cardiac resynchronization therapy in the UK.

Abstract：

OBJECTIVE:Clinical evidence supports the use of cardiac resynchronization therapy (CRT) in advanced heart failure, but its cost-effectiveness is still unclear. This analysis assessed the economic and health consequences in the UK of implanting a CRT in patients with NYHA class III-IV heart failure. METHODS:A discrete event simulation of heart failure was used to compare the course over 5 years of 1000 identical pairs of patients -- one receiving both CRT and optimum pharmacologic treatment (OPT), the other OPT alone. All inputs were obtained from the data collected in the CArdiac REsynchronization in Heart Failure (CARE-HF) trial and a hospital in the UK. Direct medical costs (in 2004 pound) from the perspective of the National Health Service were considered. Both costs and benefits were discounted at 3.5%. Sensitivity analyses addressed all model inputs and multivariate analyses were performed by varying key parameters simultaneously. RESULTS:The model predicted 471 deaths and 2263 hospitalizations over 5 years with OPT alone and 348 deaths and 1764 hospitalizations with CRT, equivalent to a 26% reduction in mortality and 22% in hospitalizations, at a discounted cost of pound 11,423 per patient with CRT vs. pound 4,900 with OPT alone. CRT was predicted to increase quality-adjusted survival by 0.43 QALYs per patient, resulting in an incremental cost-effectiveness ratio of pound 15,247 per QALY gained (range: pound 12,531- pound 23,184). Sensitivity analyses revealed that this outcome was most sensitive to time horizon and cost of implantation. CONCLUSION:Based on these 5-year analyses, CRT is expected to yield substantial health benefits at a reasonable cost.

journal_name

Curr Med Res Opin

journal_title

Current medical research and opinion

authors

Caro JJ,Guo S,Ward A,Chalil S,Malik F,Leyva F

doi

10.1185/030079906X112516

subject

Has Abstract

pub_date

2006-06-01 00:00:00

pages

1171-9

issue

6

eissn

0300-7995

issn

1473-4877

journal_volume

22

pub_type

杂志文章

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