Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial
Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial
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DOI：
10.1016/j.jacc.2005.08.033
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发表时间：
2005-12-20
影响因子：
24
通讯作者：
Gunderman, MR
中科院分区：
文献类型：
--
作者：
Feldman, AM;de Lissovoy, G;Gunderman, MR
分析的目的是估计心力衰竭药物治疗、起搏和除颤比较的增量成本效果比（ICER）（COMPANION）试验患者，相对于单独使用最佳药物治疗（OPT）的患者，接受通过起搏器（CRT-P）或起搏器-除颤器（CRT-D）的心脏起搏治疗（CRT）联合最佳药物治疗（OPT）的患者。CRT-P和CRT-D降低了晚期心力衰竭和心室内传导延迟患者的全因死亡率或首次住院的综合风险，但该治疗的成本效益仍未知。在本分析中，对意向治疗试验数据进行建模，以估计CRT-D和CRT-P相对于OPT在基础病例7年治疗事件的成本效益。指数生存曲线来源于试验数据，并通过生活质量试验结果进行调整，以获得质量调整生命年（Qs）。前两年，随访住院治疗是基于试验数据。该模型假设两年后的住院率相等。初始植入和后续住院费用估计使用医疗保险data.Results超过两年，后续住院费用减少了29%的CRT-D和37%的CRT-P。延长成本效益分析，以7年为基础的情况下，ICER的CRT-P是19,600美元每QALY和ICER的CRT-D是43美元，结论：对于COMPANION试验患者，使用CRT-P和CRT-D的成本效益比低于普遍接受的治疗干预基准（每QALY 50，000美元至每QALY 100，000美元）。这表明CRT-P和CRT-D的临床受益可以在合理的成本下实现。
OBJECTIVES The analysis goal was to estimate incremental cost-effectiveness ratios (ICERs) for the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial patients who received cardiac resynchronization therapy (CRT) via pacemaker (CRT-P) or pacemaker-defibriflator (CRT-D) in combination with optimal pharmacological therapy (OPT) relative to patients with OPT alone.BACKGROUND In the COMPANION trial, CRT-P and CRT-D reduced the combined risk of all-cause mortality or first hospitalization among patients with advanced heart failure and intraventricular conduction delays, but the cost effiectiveness of the therapy remains unknown.METHODS In this analysis, intent-to-treat trial data were modeled to estimate the cost effectiveness of CRT-D and CRT-P relative to OPT over a base-case seven-year treatment episode. Exponential survival curves were derived from trial data and adjusted by quality-of-life trial results to yield quality-adjusted life-years (QALYs). For the first two years, follow-up hospitalizations were based on trial data. The model assumed equalized hospitalization rates beyond two years. Initial implantation and follow-up hospitalization costs were estimated using Medicare data.RESULTS Over two years, follow-up hospitalization costs were reduced by 29% for CRT-D and 37% for CRT-P. Extending the cost-effectiveness analysis to a seven-year base-case time period, the ICER for CRT-P was $19,600 per QALY and the ICER for CRT-D was $43,000 per QALY relative to OPT.CONCLUSIONS For the COMPANION trial patients, the use of CRT-P and CRT-D was associated with a cost-effiectiveness ratio below generally accepted benchmarks for therapeutic interventions of $50,000 per QALY to $100,000 per QALY. This suggests that the clinical benefits of CRT-P and CRT-D can be achieved at a reasonable cost.