RT Journal Article
SR Electronic
T1 Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 416
OP 422
DO 10.1136/heartjnl-2017-311749
VO 104
IS 5
A1 Simon Claridge
A1 Frederic A Sebag
A1 Steven Fearn
A1 Jonathan M Behar
A1 Bradley Porter
A1 Tom Jackson
A1 Benjamin Sieniewicz
A1 Justin Gould
A1 Jessica Webb
A1 Zhong Chen
A1 Mark O’Neill
A1 Jaswinder Gill
A1 Christophe Leclercq
A1 Christopher A Rinaldi
YR 2018
UL http://heart.bmj.com/content/104/5/416.abstract
AB Objective Responders to cardiac resynchronisation therapy whose device has a defibrillator component and who do not receive a therapy in the lifetime of the first generator have a very low incidence of appropriate therapy after box change. We investigated the cost implications of using a risk stratification tool at the time of generator change resulting in these patients being reimplanted with a resynchronisation pacemaker.Methods A decision tree was created using previously published data which had demonstrated an annualised appropriate defibrillator therapy risk of 2.33%. Costs were calculated at National Health Service (NHS) national tariff rates (2016–2017). EQ-5D utility values were applied to device reimplantations, admissions and mortality data, which were then used to estimate quality-adjusted life-years (QALYs) over 5 years.Results At 5 years, the incremental cost of replacing a resynchronisation defibrillator device with a second resynchronisation defibrillator versus resynchronisation pacemaker was £5045 per patient. Incremental QALY gained was 0.0165 (defibrillator vs pacemaker), resulting in an incremental cost-effectiveness ratio (ICER) of £305 712 per QALYs gained. Probabilistic sensitivity analysis resulted in an ICER of £313 612 (defibrillator vs pacemaker). For reimplantation of all patients with a defibrillator rather than a pacemaker to yield an ICER of less than £30 000 per QALY gained (current NHS cut-off for approval of treatment), the annual arrhythmic event rate would need to be 9.3%. The budget impact of selective replacement was a saving of £2 133 985 per year.Conclusions Implanting low-risk patients with a resynchronisation defibrillator with the same device at the time of generator change is not cost-effective by current NHS criteria. Further research is required to understand the impact of these findings on individual patients at the time of generator change.