BOSTON—Cardiac resynchronization therapy-defibrillator (CRT-D) is an attractive option for mild-to-moderate heart failure (HF) patients. When compared to implantable cardioverter-defibrillators (ICDs) these patients may get more bang for their buck in two ways—lower costs and better outcomes, according to an economic analysis of the RAFT trial presented May 11 at the annual scientific sessions of the Heart Rhythm Society.
The analysis used economic data derived from the 2010 RAFT (Resynchronization/Defibrillation in Ambulatory Heart Failure Trial) trial that examined the outcomes of CRT-D and ICD in mild-to-moderate HF patients. The economic analysis set out to evaluate whether CRT-D was a cost-effective therapy for this patient population.
The previously reported RAFT trial randomized patients at a 1:1 ratio to receive either an ICD (904 patients) or CRT-D (894 patients). The trial had an average follow-up of 40 months. Results showed CRT patients fared better than ICD patients in terms of death and hospitalization for HF, said George A. Wells, PhD, MSc, professor of the department of epidemiology and community medicine at the University of Ottawa Heart Institute in Canada.
For the economic analysis, Wells et al collected cost information on devices, device replacements, hospitalizations, resource information on long-term care, physician costs and drug costs. The researchers used quality of life year gain (QALY) to assess cost-effectiveness. These were determined through questionnaires and later electronically assessed.
The analysis showed total costs for ICDs to be $134,469 vs. $162,199 for CRT-D. QALYs were improved with CRT compared with ICD, 5.8 vs. 4.7. Therefore, CRT-D patients gained more than one QALY at an additional cost that equated to $35,308 over a lifetime.
Wells calculated a $33,594 cost per QALY gained for CRT-D. “What does this number mean?” he asked.
Generally the industry uses certain benchmarks to help understand whether a procedure is cost effective and economically attractive. Wells said that if the device or procedure is over $100,000 per QALY then it is not considered to be attractive economically; however, if it is less than $50,000 per QALY it is considered to be attractive economically.
How do other cardiac management devices compare? Wells reported that therapeutic hypothermia devices equate to $47,000 per QALY while TAVI is $62,000 per QALY and left ventricular assist devices are $56,000 per QALY.
“Overall, CRT-D is cost effective for patients in the RAFT trial,” Wells summed. Wells et al said that SCD-HeFT, COMPANION and CARE HF trials found the QALYs to be similar to that of the RAFT trial economic data.
Last month, the FDA expanded indications for Medtronic CRT-D devices to include patients with a New York Heart Association Class II HF, those with a left ventricular ejection fraction of less than or equal to 30 percent, patients with left bundle branch block and those who have a QRS duration greater than 130 ms.