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Cost-Effectiveness Analysis of Quadripolar Versus Bipolar Left Ventricular Leads for Cardiac Resynchronization Defibrillator Therapy in a Large, Multicenter UK Registry

OBJECTIVES: The objective of this study was to evaluate the cost-effectiveness of quadripolar versus bipolar cardiac resynchronization defibrillator therapy systems. BACKGROUND: Quadripolar left ventricular (LV) leads for cardiac resynchronization therapy reduce phrenic nerve stimulation (PNS) and a...

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Autores principales: Behar, Jonathan M., Chin, Hui Men Selina, Fearn, Steve, Ormerod, Julian O.M., Gamble, James, Foley, Paul W.X., Bostock, Julian, Claridge, Simon, Jackson, Tom, Sohal, Manav, Antoniadis, Antonios P., Razavi, Reza, Betts, Tim R., Herring, Neil, Rinaldi, Christopher Aldo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Inc 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328196/
https://www.ncbi.nlm.nih.gov/pubmed/28280785
http://dx.doi.org/10.1016/j.jacep.2016.04.009
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author Behar, Jonathan M.
Chin, Hui Men Selina
Fearn, Steve
Ormerod, Julian O.M.
Gamble, James
Foley, Paul W.X.
Bostock, Julian
Claridge, Simon
Jackson, Tom
Sohal, Manav
Antoniadis, Antonios P.
Razavi, Reza
Betts, Tim R.
Herring, Neil
Rinaldi, Christopher Aldo
author_facet Behar, Jonathan M.
Chin, Hui Men Selina
Fearn, Steve
Ormerod, Julian O.M.
Gamble, James
Foley, Paul W.X.
Bostock, Julian
Claridge, Simon
Jackson, Tom
Sohal, Manav
Antoniadis, Antonios P.
Razavi, Reza
Betts, Tim R.
Herring, Neil
Rinaldi, Christopher Aldo
author_sort Behar, Jonathan M.
collection PubMed
description OBJECTIVES: The objective of this study was to evaluate the cost-effectiveness of quadripolar versus bipolar cardiac resynchronization defibrillator therapy systems. BACKGROUND: Quadripolar left ventricular (LV) leads for cardiac resynchronization therapy reduce phrenic nerve stimulation (PNS) and are associated with reduced mortality compared with bipolar leads. METHODS: A total of 606 patients received implants at 3 UK centers (319 Q, 287 B), between 2009 and 2014; mean follow-up was 879 days. Rehospitalization episodes were costed at National Health Service national tariff rates, and EQ-5D utility values were applied to heart failure admissions, acute coronary syndrome events, and mortality data, which were used to estimate quality-adjusted life-year differences over 5 years. RESULTS: Groups were matched with regard to age and sex. Patients with quadripolar implants had a lower rate of hospitalization than those with bipolar implants (42.6% vs. 55.4%; p = 0.002). This was primarily driven by fewer hospital readmissions for heart failure (51 [16%] vs. 75 [26.1%], respectively, for quadripolar vs. bipolar implants; p = 0.003) and generator replacements (9 [2.8%] vs. 19 [6.6%], respectively; p = 0.03). Hospitalization for suspected acute coronary syndrome, arrhythmia, device explantation, and lead revisions were similar. This lower health-care utilization cost translated into a cumulative 5-year cost saving for patients with quadripolar systems where the acquisition cost was <£932 (US $1,398) compared with bipolar systems. Probabilistic sensitivity analysis results mirrored the deterministic calculations. For the average additional price of £1,200 (US $1,800) over a bipolar system, the incremental cost-effective ratio was £3,692 per quality-adjusted life-year gained (US $5,538), far below the usual willingness-to-pay threshold of £20,000 (US $30,000). CONCLUSIONS: In a UK health-care 5-year time horizon, the additional purchase price of quadripolar cardiac resynchronization defibrillator therapy systems is largely offset by lower subsequent event costs up to 5 years after implantation, which makes this technology highly cost-effective compared with bipolar systems.
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spelling pubmed-53281962017-03-07 Cost-Effectiveness Analysis of Quadripolar Versus Bipolar Left Ventricular Leads for Cardiac Resynchronization Defibrillator Therapy in a Large, Multicenter UK Registry Behar, Jonathan M. Chin, Hui Men Selina Fearn, Steve Ormerod, Julian O.M. Gamble, James Foley, Paul W.X. Bostock, Julian Claridge, Simon Jackson, Tom Sohal, Manav Antoniadis, Antonios P. Razavi, Reza Betts, Tim R. Herring, Neil Rinaldi, Christopher Aldo JACC Clin Electrophysiol New Research Paper OBJECTIVES: The objective of this study was to evaluate the cost-effectiveness of quadripolar versus bipolar cardiac resynchronization defibrillator therapy systems. BACKGROUND: Quadripolar left ventricular (LV) leads for cardiac resynchronization therapy reduce phrenic nerve stimulation (PNS) and are associated with reduced mortality compared with bipolar leads. METHODS: A total of 606 patients received implants at 3 UK centers (319 Q, 287 B), between 2009 and 2014; mean follow-up was 879 days. Rehospitalization episodes were costed at National Health Service national tariff rates, and EQ-5D utility values were applied to heart failure admissions, acute coronary syndrome events, and mortality data, which were used to estimate quality-adjusted life-year differences over 5 years. RESULTS: Groups were matched with regard to age and sex. Patients with quadripolar implants had a lower rate of hospitalization than those with bipolar implants (42.6% vs. 55.4%; p = 0.002). This was primarily driven by fewer hospital readmissions for heart failure (51 [16%] vs. 75 [26.1%], respectively, for quadripolar vs. bipolar implants; p = 0.003) and generator replacements (9 [2.8%] vs. 19 [6.6%], respectively; p = 0.03). Hospitalization for suspected acute coronary syndrome, arrhythmia, device explantation, and lead revisions were similar. This lower health-care utilization cost translated into a cumulative 5-year cost saving for patients with quadripolar systems where the acquisition cost was <£932 (US $1,398) compared with bipolar systems. Probabilistic sensitivity analysis results mirrored the deterministic calculations. For the average additional price of £1,200 (US $1,800) over a bipolar system, the incremental cost-effective ratio was £3,692 per quality-adjusted life-year gained (US $5,538), far below the usual willingness-to-pay threshold of £20,000 (US $30,000). CONCLUSIONS: In a UK health-care 5-year time horizon, the additional purchase price of quadripolar cardiac resynchronization defibrillator therapy systems is largely offset by lower subsequent event costs up to 5 years after implantation, which makes this technology highly cost-effective compared with bipolar systems. Elsevier Inc 2017-02 /pmc/articles/PMC5328196/ /pubmed/28280785 http://dx.doi.org/10.1016/j.jacep.2016.04.009 Text en © 2017 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle New Research Paper
Behar, Jonathan M.
Chin, Hui Men Selina
Fearn, Steve
Ormerod, Julian O.M.
Gamble, James
Foley, Paul W.X.
Bostock, Julian
Claridge, Simon
Jackson, Tom
Sohal, Manav
Antoniadis, Antonios P.
Razavi, Reza
Betts, Tim R.
Herring, Neil
Rinaldi, Christopher Aldo
Cost-Effectiveness Analysis of Quadripolar Versus Bipolar Left Ventricular Leads for Cardiac Resynchronization Defibrillator Therapy in a Large, Multicenter UK Registry
title Cost-Effectiveness Analysis of Quadripolar Versus Bipolar Left Ventricular Leads for Cardiac Resynchronization Defibrillator Therapy in a Large, Multicenter UK Registry
title_full Cost-Effectiveness Analysis of Quadripolar Versus Bipolar Left Ventricular Leads for Cardiac Resynchronization Defibrillator Therapy in a Large, Multicenter UK Registry
title_fullStr Cost-Effectiveness Analysis of Quadripolar Versus Bipolar Left Ventricular Leads for Cardiac Resynchronization Defibrillator Therapy in a Large, Multicenter UK Registry
title_full_unstemmed Cost-Effectiveness Analysis of Quadripolar Versus Bipolar Left Ventricular Leads for Cardiac Resynchronization Defibrillator Therapy in a Large, Multicenter UK Registry
title_short Cost-Effectiveness Analysis of Quadripolar Versus Bipolar Left Ventricular Leads for Cardiac Resynchronization Defibrillator Therapy in a Large, Multicenter UK Registry
title_sort cost-effectiveness analysis of quadripolar versus bipolar left ventricular leads for cardiac resynchronization defibrillator therapy in a large, multicenter uk registry
topic New Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328196/
https://www.ncbi.nlm.nih.gov/pubmed/28280785
http://dx.doi.org/10.1016/j.jacep.2016.04.009
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