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  • International Journal of Technology Assessment in Health Care, Volume 29, Issue 2
  • April 2013, pp. 140-146


  • Luis Almenar (a1), Beatriz Díaz (a2), Aurelio Quesada (a3), Carlos Crespo (a4), Belén Martí (a5), Stuart Mealing (a6), Cecilia Linde (a7) and Claude Daubert (a8)
  • DOI:
  • Published online: 03 April 2013

Objectives: The aim of the study was to combine clinical results from the European Cohort of the REVERSE study and costs associated with the addition of cardiac resynchronization therapy (CRT) to optimal medical therapy (OMT) in patients with mild symptomatic (NYHA I-II) or asymptomatic left ventricular dysfunction and markers of cardiac dyssynchrony in Spain.

Methods: A Markov model was developed with CRT + OMT (CRT-ON) versus OMT only (CRT-OFF) based on a retrospective cost-effectiveness analysis. Raw data was derived from literature and expert opinion, reflecting clinical and economic consequences of patient's management in Spain. Time horizon was 10 years. Both costs (euro 2010) and effects were discounted at 3 percent per annum.

Results: CRT-ON showed higher total costs than CRT-OFF; however, CRT reduced the length of hospitalization in ICU by 94 percent (0.006 versus 0.091 days) and general ward in by 34 percent (0.705 versus 1.076 days). Surviving CRT-ON patients (88.2 percent versus 77.5 percent) remained in better functional class longer, and they achieved an improvement of 0.9 life years (LYGs) and 0.77 years quality-adjusted life years (QALYs). CRT-ON proved to be cost-effective after 6 years, except for the 7th year due to battery depletion. At 10 years, the results were €18,431 per LYG and €21,500 per QALY gained. Probabilistic sensitivity analysis showed CRT-ON was cost-effective in 75.4 percent of the cases at 10 years.

Conclusions: The use of CRT added to OMT represents an efficient use of resources in patients suffering from heart failure in NYHA functional classes I and II.

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2.JR Banegas , F Rodríguez-Artalejo , P. Guallar-Castillón [Epidemiological situation of heart failure in Spain]. Rev Esp Cardiol. 2006;6 (Suppl C):49.

5.FM Gomez-Soto , JL Andrey , AA García-Egido , et al.Incidence and mortality of heart failure: A community-based study. Int J Cardiol. 2011;151:4045.

6.D Callejo , M Guerra , A Hernández-Madrid , JA. Blasco Economic assessment of cardiac resynchronization therapy. Rev Esp Cardiol. 2010;63:12351243.

7.MJ Calvert , N Freemantle , G Yao , et al.Cost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial. Eur Heart J. 2005;26:26812688.

9.C Daubert , MR Gold , WT Abraham , et al.Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insights from de European cohort of REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial. J Am Coll Cardiol. 2009;54;18371846.

10.AJ Moss , W Jackson , DS Cannom , H Klein , MW Brown , MADIT-CRT trial investigators. Cardiac-resynchronization therapy for the prevention of heart failure events. N Engl J Med. 2009;361:13291338.

11.C Linde , S Mealing , N Hawkins , et al.Cost-effectiveness of cardiac resynchronization therapy in patients with asymptomatic to mild heart failure: insights from the European cohort of the REVERSE (Resynchronization Reverses remodeling in Systolic Left Ventricular Dysfunction). Eur Heart J. 2011;32:16311639.

12.M Fox , S Mealing , R Anderson , et al.The clinical effectiveness and cost-effectiveness of cardiac resynchronisation (biventricular pacing) for heart failure: systematic review and economic model. Health Technol Assess. 2007;11:1168, iii-iv, ix-248.

16.JA Sacristán , J Oliva , J Del Llano , L Prieto , JL. Pinto What is an efficient health technology in Spain? Gac Sanit. 2002;16:334343.

17.AM Feldman , G de Lissovoy , MR Bristow , et al.Cost effectiveness of cardiac resynchronisation therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial. J Am Coll Cardiol. 2005;46:23112321.

19.MG St John Sutton , T Plappert , WT Abraham , et al.Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation. 2003;107:19851990.

20.SL Higgins , JD Hummel , IK Niazi , et al.Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias. J Am Coll Cardiol. 2003;42:14541459.

21.C Alonso , P Ritter , C Leclercq , et al.Effects of cardiac resynchronization therapy on heart rate variability in patients with chronic systolic heart failure and intraventricular conduction delay. Am J Cardiol. 2003;91:11441147.

22.G Yao , N Freemantle , MJ Calvert , et al.The long term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator. Eur Heart J. 2007;28:4251.

23.R Muñoz , J Martínez-Ferrer , J Delgado , et al.[Can cardiac resynchronization therapy added to optimize pharmacological treatment make up in patients with heart failure in Spain?]. PharmacoEconomics Sp Res Art. 2010;7:1325.

24.AS Tang , GA Wells , M Talajic , et al.Resynchronization-defibrillation for ambulatory heart failure trial investigators. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010;363:23852395.

25.MJ Calvert , N Freemantle , JG. Cleland Cardiac resynchronisation therapy is cost effective. Rev Esp Cardiol. 2010;63:12301231.

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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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