Cardiology Department, Hospital Universitario La Fe, Valencia, Spain.
Int J Technol Assess Health Care. 2013 Apr;29(2):140-6. doi: 10.1017/S0266462313000123. Epub 2013 Apr 3.
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.
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.
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.
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.
本研究旨在结合欧洲 REVERSE 研究队列的临床结果以及在西班牙伴有心脏不同步标志物的轻度症状性（NYHA I-II 级）或无症状左心室功能障碍患者中添加心脏再同步治疗（CRT）与最佳药物治疗（OMT）相关的成本。
基于回顾性成本效益分析，建立了一个包含 CRT+OMT（CRT-ON）与仅 OMT（CRT-OFF）的 Markov 模型。原始数据来源于文献和专家意见，反映了西班牙患者管理的临床和经济后果。时间范围为 10 年。所有成本（2010 年欧元）和效果均按 3%的年利率贴现。
CRT-ON 的总成本高于 CRT-OFF；然而，CRT 可将 ICU 住院时间缩短 94%（0.006 天与 0.091 天），普通病房住院时间缩短 34%（0.705 天与 1.076 天）。存活的 CRT-ON 患者（88.2%与 77.5%）在更长时间内保持更好的功能状态，并且获得了 0.9 个生命年（LYG）和 0.77 年质量调整生命年（QALY）的改善。在第 6 年之后，CRT-ON 具有成本效益，除了第 7 年由于电池耗尽的原因。在第 10 年，每获得一个 LYG 的成本为 18431 欧元，每获得一个 QALY 的成本为 21500 欧元。概率敏感性分析显示，在第 10 年，CRT-ON 在 75.4%的情况下具有成本效益。
在 NYHA 功能分级 I 和 II 的心力衰竭患者中，CRT 联合 OMT 的应用是对资源的有效利用。
