Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial

Arthur M. Feldman, Gregory De Lissovoy, Michael R. Bristow, Leslie A. Saxon, Teresa De Marco, David A. Kass, John Boehmer, Steven Singh, David J. Whellan, Peter Carson, Audra Boscoe, Timothy M. Baker, Matthew R. Gunderman

Research output: Contribution to journalArticle

143 Citations (Scopus)

Abstract

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-defibrillator (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 effectiveness 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-effectiveness 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.

Original languageEnglish (US)
Pages (from-to)2311-2321
Number of pages11
JournalJournal of the American College of Cardiology
Volume46
Issue number12
DOIs
StatePublished - Dec 20 2005

Fingerprint

Cardiac Resynchronization Therapy
Cost-Benefit Analysis
Heart Failure
Quality-Adjusted Life Years
Hospitalization
Therapeutics
Pharmacology
Costs and Cost Analysis
Benchmarking
Defibrillators
Medicare

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Feldman, Arthur M. ; De Lissovoy, Gregory ; Bristow, Michael R. ; Saxon, Leslie A. ; De Marco, Teresa ; Kass, David A. ; Boehmer, John ; Singh, Steven ; Whellan, David J. ; Carson, Peter ; Boscoe, Audra ; Baker, Timothy M. ; Gunderman, Matthew R. / Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial. In: Journal of the American College of Cardiology. 2005 ; Vol. 46, No. 12. pp. 2311-2321.
@article{492032b68b244bf48181a0f3759bf018,
title = "Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial",
abstract = "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-defibrillator (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 effectiveness 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-effectiveness 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.",
author = "Feldman, {Arthur M.} and {De Lissovoy}, Gregory and Bristow, {Michael R.} and Saxon, {Leslie A.} and {De Marco}, Teresa and Kass, {David A.} and John Boehmer and Steven Singh and Whellan, {David J.} and Peter Carson and Audra Boscoe and Baker, {Timothy M.} and Gunderman, {Matthew R.}",
year = "2005",
month = "12",
day = "20",
doi = "10.1016/j.jacc.2005.08.033",
language = "English (US)",
volume = "46",
pages = "2311--2321",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "12",

}

Feldman, AM, De Lissovoy, G, Bristow, MR, Saxon, LA, De Marco, T, Kass, DA, Boehmer, J, Singh, S, Whellan, DJ, Carson, P, Boscoe, A, Baker, TM & Gunderman, MR 2005, 'Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial', Journal of the American College of Cardiology, vol. 46, no. 12, pp. 2311-2321. https://doi.org/10.1016/j.jacc.2005.08.033

Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial. / Feldman, Arthur M.; De Lissovoy, Gregory; Bristow, Michael R.; Saxon, Leslie A.; De Marco, Teresa; Kass, David A.; Boehmer, John; Singh, Steven; Whellan, David J.; Carson, Peter; Boscoe, Audra; Baker, Timothy M.; Gunderman, Matthew R.

In: Journal of the American College of Cardiology, Vol. 46, No. 12, 20.12.2005, p. 2311-2321.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial

AU - Feldman, Arthur M.

AU - De Lissovoy, Gregory

AU - Bristow, Michael R.

AU - Saxon, Leslie A.

AU - De Marco, Teresa

AU - Kass, David A.

AU - Boehmer, John

AU - Singh, Steven

AU - Whellan, David J.

AU - Carson, Peter

AU - Boscoe, Audra

AU - Baker, Timothy M.

AU - Gunderman, Matthew R.

PY - 2005/12/20

Y1 - 2005/12/20

N2 - 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-defibrillator (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 effectiveness 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-effectiveness 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.

AB - 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-defibrillator (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 effectiveness 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-effectiveness 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.

UR - http://www.scopus.com/inward/record.url?scp=28944449941&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=28944449941&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2005.08.033

DO - 10.1016/j.jacc.2005.08.033

M3 - Article

C2 - 16360064

AN - SCOPUS:28944449941

VL - 46

SP - 2311

EP - 2321

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 12

ER -