Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
Int J Technol Assess Health Care. 2012 Oct;28(4):429-35. doi: 10.1017/S0266462312000505. Epub 2012 Sep 24.
Cardiac resynchronization therapy (CRT) has recently been shown to reduce both mid-term and long-term mortality in patients with mild heart failure. Although proven effective, it is unclear whether CRT is cost-effective in low and middle-income countries (LMIC). Therefore, we set out to analyze the cost-effectiveness of CRT in Argentina in patients with New York Heart Association (NYHA) functional class (FC) I or II heart failure (HF). We chose to compare patients receiving optimal medical treatment (OMT) and CRT with those patients receiving only OMT.
We constructed a Markov model with a cohort simulation, and a life-time horizon to assess costs, life-years, and quality-adjusted life-year (QALY) gained as a result of treatment with both CRT and OMT from an Argentine third party payer perspective. We included patients who met the following criteria: left ventricular ejection fraction (LVEF) ≤ 40 percent, sinus rhythm with a QRS ≥ 120 msec, and NYHA FC I-II HF. The results were expressed as cost per life-year and QALY gained in international dollars (ID$) for the year 2009.
For the base case analysis performed, we started at a fixed age of 65. After applying a 3 percent annual discount rate, the incremental cost-effectiveness ratio (ICER) was 38.005 ID$ per year of life gained and 34.185 ID$ per QALY gained.
Long-term treatment with CRT appears to be cost-effective in Argentina compared with patients treated solely with OMT. Similar analysis should be performed to determine if this treatment option is cost-effective in other LMIC.
心脏再同步治疗（CRT）最近已被证明可降低轻度心力衰竭患者的中期和长期死亡率。尽管已被证实有效，但 CRT 在中低收入国家（LMIC）是否具有成本效益尚不清楚。因此，我们着手分析 CRT 在阿根廷纽约心脏协会（NYHA）功能分级（FC）I 或 II 心力衰竭（HF）患者中的成本效益。我们选择比较接受最佳药物治疗（OMT）和 CRT 的患者与仅接受 OMT 的患者。
我们构建了一个马尔可夫模型，进行队列模拟，以及终身时间跨度，以从阿根廷第三方支付者的角度评估 CRT 和 OMT 治疗的成本、寿命和获得的质量调整生命年（QALY）。我们纳入了符合以下标准的患者：左心室射血分数（LVEF）≤40%，窦性心律伴 QRS≥120 msec，NYHA FC I-II HF。结果以国际美元（ID$）表示，用于 2009 年的每生命年和 QALY 获得成本。
对于进行的基本情况分析，我们从固定的 65 岁开始。应用 3%的年度贴现率后，增量成本效益比（ICER）为每年 38.005 ID$的生命获得和每年 34.185 ID$的 QALY 获得。
与仅接受 OMT 治疗的患者相比，长期接受 CRT 治疗在阿根廷似乎具有成本效益。应进行类似的分析，以确定这种治疗选择在其他 LMIC 是否具有成本效益。
