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      Cost-effectiveness of cardiac resynchronization therapy plus an implantable cardioverter-defibrillator in patients with heart failure: a systematic review

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          Abstract

          Introduction

          Heart failure (HF) is an unusual heart function that causes reduction in cardiac or pulmonary output. Cardiac resynchronization therapy (CRT) is a mechanical device that helps to recover ventricular dysfunction by pacing the ventricles. This study planned to systematically review cost-effectiveness of CRT combined with an implantable cardioverter-defibrillator (ICD) versus ICD in patients with HF.

          Methods

          We used five databases (NHS Economic Evaluation Database, Cochrane Library, Medline, PubMed, and Scopus) to systematically reviewed studies published in the English language on the cost-effectiveness of CRT with defibrillator (CRT-D) Vs. ICD in patients with HF over 2000 to 2020. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to assess the quality of the selected studies.

          Results

          Five studies reporting the cost-effectiveness of CRT-D vs ICD were finally identified. The results revealed that time horizon, direct medical costs, type of model, discount rate, and sensitivity analysis obviously mentioned in almost all studies. All studies used quality-adjusted life years (QALYs) as an effectiveness measurement. The highest and the lowest Incremental cost-effectiveness ratio (ICER) were reported in the USA ($138,649per QALY) and the UK ($41,787per QALY), respectively.

          Conclusion

          Result of the study showed that CRT-D compared to ICD alone was the most cost-effective treatment in patients with HF.

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          Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association.

          Paul A Heidenreich, Nancy M Albert, Larry A Allen … (2013)
          Heart failure (HF) is an important contributor to both the burden and cost of national healthcare expenditures, with more older Americans hospitalized for HF than for any other medical condition. With the aging of the population, the impact of HF is expected to increase substantially. We estimated future costs of HF by adapting a methodology developed by the American Heart Association to project the epidemiology and future costs of HF from 2012 to 2030 without double counting the costs attributed to comorbid conditions. The model assumes that HF prevalence will remain constant by age, sex, and race/ethnicity and that rising costs and technological innovation will continue at the same rate. By 2030, >8 million people in the United States (1 in every 33) will have HF. Between 2012 and 2030, real (2010$) total direct medical costs of HF are projected to increase from $21 billion to $53 billion. Total costs, including indirect costs for HF, are estimated to increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be 3-fold higher ($160 billion in direct costs). The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed.
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            Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

            Don Husereau, Michael F Drummond, Stavros Petrou … (2013)
            Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.
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              Survival of patients with a new diagnosis of heart failure: a population based study.

              M R Cowie, D Wood, A. Coats … (2000)
              To describe the survival of a population based cohort of patients with incident (new) heart failure and the clinical features associated with mortality. A population based observational study. Population of 151 000 served by 82 general practitioners in west London. New cases of heart failure were identified by daily surveillance of acute hospital admissions to the local district general hospital, and by general practitioner referral of all suspected new cases of heart failure to a rapid access clinic. All patients with suspected heart failure underwent clinical assessment, and chest radiography, ECG, and echocardiogram were performed. A panel of three cardiologists reviewed all the data and determined whether the definition of heart failure had been met. Patients were subsequently managed by the general practitioner in consultation with the local cardiologist or admitting physician. Death, overall and from cardiovascular causes. There were 90 deaths (83 cardiovascular deaths) in the cohort of 220 patients with incident heart failure over a median follow up of 16 months. Survival was 81% at one month, 75% at three months, 70% at six months, 62% at 12 months, and 57% at 18 months. Lower systolic blood pressure, higher serum creatinine concentration, and greater extent of crackles on auscultation of the lungs were independently predictive of cardiovascular mortality (all p < 0.001). In patients with new heart failure, mortality is high in the first few weeks after diagnosis. Simple clinical features can identify a group of patients at especially high risk of death.
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                Author and article information

                Contributors
                Aziz Rezapour: rezapour.a@iums.ac.ir
                Journal
                Journal ID (nlm-ta): Cost Eff Resour Alloc
                Journal ID (iso-abbrev): Cost Eff Resour Alloc
                Title: Cost Effectiveness and Resource Allocation : C/E
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1478-7547
                Publication date (Electronic): 21 May 2021
                Publication date PMC-release: 21 May 2021
                Publication date Collection: 2021
                Volume: 19
                Electronic Location Identifier: 31
                Affiliations
                [1 ]GRID grid.411746.1, ISNI 0000 0004 4911 7066, Department of Health Economics, School of Health Management and Information Sciences, , Iran University of Medical Sciences, ; Tehran, Iran
                [2 ]GRID grid.411746.1, ISNI 0000 0004 4911 7066, Health Management and Economics Research Center, School of Health Management and Information Sciences, , Iran University of Medical Sciences, ; Tehran, Iran
                [3 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Tehran Heart Center, Tehran University of Medical Sciences, ; Tehran, Iran
                Article
                Publisher ID: 285
                DOI: 10.1186/s12962-021-00285-5
                PMC ID: 8139093
                SO-VID: 83053eab-269b-479e-969b-b183035e7402
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 9 October 2020
                Date accepted : 11 May 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100012021, Iran University of Medical Sciences;
                Award ID: IUMS/SHMIS_97-3-37-12819
                Award Recipient :
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Public health
                Keywords: heart failure,cost-effectiveness,implantable cardiac devices,systematic review
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: heart failure, cost-effectiveness, implantable cardiac devices, systematic review

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