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

146 Scopus citations

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

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial'. Together they form a unique fingerprint.

  • Cite this

    Feldman, A. M., De Lissovoy, G., Bristow, M. R., Saxon, L. A., De Marco, T., Kass, D. A., Boehmer, J., Singh, S., Whellan, D. J., Carson, P., Boscoe, A., Baker, T. M., & Gunderman, M. R. (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, 46(12), 2311-2321. https://doi.org/10.1016/j.jacc.2005.08.033