Cost-effectiveness analysis of leadless cardiac resynchronization therapy.
Cost-effectiveness analysis of leadless cardiac resynchronization therapy.
复制标题
无引线心脏再同步治疗的成本效益分析。
DOI：
10.1111/jce.16102
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发表时间：
2023
影响因子：
2.7
通讯作者：
Rinaldi,ChristopherA
中科院分区：
文献类型：
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作者：
Wijesuriya,Nadeev;Mehta,Vishal;Vere,FelicityDe;Howell,Sandra;Behar,JonathanM;Shute,Andrew;Lee,Michael;Bosco,Paolo;Niederer,StevenA;Rinaldi,ChristopherA
背景CRT无线心内刺激（WiSE-CRT）系统是一种通过提供无导线心脏起搏治疗（CRT）来治疗不同步性心力衰竭（HF）患者的新技术。观察性研究已经证明了它的安全性和有效性，然而，治疗成本效益尚未被检查。MethodsA成本效益评估的WiSE-CRT系统进行了基于队列的经济模型，采用“比例状态”的结构。除主要分析外，还进行了情景分析和敏感性分析，以测试输入参数的不确定性。结果进行了量化的质量调整生命年（QALY）的differentiation.ResultsThe主要分析表明，治疗与WiSE-CRT系统可能是具有成本效益的终身范围内的QALY报销阈值为20 000英镑，与净货币效益（NMB）的£3781每QALY。成本效益下降的时间跨度短于10年。敏感性分析表明，平均系统电池寿命对潜在的cost-effectiveness.ConclusionWithin模型的局限性，这些研究结果支持使用WiSE-CRT的指示患者从经济的角度来看。然而，在医疗服务面临巨大财政压力的时候，应该优先考虑改进电池技术，以最大限度地提高成本效益。
BackgroundThe Wireless Stimulation Endocardially for CRT (WiSE‐CRT) system is a novel technology used to treat patients with dyssynchronous heart failure (HF) by providing leadless cardiac resynchronization therapy (CRT). Observational studies have demonstrated its safety and efficacy profile, however, the treatment cost‐effectiveness has not previously been examined.MethodsA cost‐effectiveness evaluation of the WiSE‐CRT System was performed using a cohort‐based economic model adopting a “proportion in state” structure. In addition to the primary analysis, scenario analyses and sensitivity analyses were performed to test for uncertainty in input parameters. Outcomes were quantified in terms of quality‐adjusted life year (QALY) differences.ResultsThe primary analysis demonstrated that treatment with the WiSE‐CRT system is likely to be cost‐effective over a lifetime horizon at a QALY reimbursement threshold of £20 000, with a net monetary benefit (NMB) of £3781 per QALY. Cost‐effectiveness declines at time horizons shorter than 10 years. Sensitivity analyses demonstrated that average system battery life had the largest impact on potential cost‐effectiveness.ConclusionWithin the model limitations, these findings support the use of WiSE‐CRT in indicated patients from an economic standpoint. However, improving battery technology should be prioritized to maximize cost‐effectiveness in times when health services are under significant financial pressures.