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Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand

BACKGROUND: Cardiac resynchronization therapy (CRT) improves symptoms and survival in patients with heart failure (HF). However, the CRT devices are costly and can impose a significant burden to the relatively constrained health budgets of middle-income countries such as Thailand. The aim of this st...

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Autores principales: Permsuwan, Unchalee, Phrommintikul, Arintaya, Silavanich, Voratima
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569046/
https://www.ncbi.nlm.nih.gov/pubmed/33116697
http://dx.doi.org/10.2147/CEOR.S268553
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author Permsuwan, Unchalee
Phrommintikul, Arintaya
Silavanich, Voratima
author_facet Permsuwan, Unchalee
Phrommintikul, Arintaya
Silavanich, Voratima
author_sort Permsuwan, Unchalee
collection PubMed
description BACKGROUND: Cardiac resynchronization therapy (CRT) improves symptoms and survival in patients with heart failure (HF). However, the CRT devices are costly and can impose a significant burden to the relatively constrained health budgets of middle-income countries such as Thailand. The aim of this study was to analyze the cost-effectiveness of CRT in combination with optimal medical therapy (OMT) relative to patients with OMT alone. METHODS: A two-component model was used to analyze lifetime costs and quality-adjusted life-years (QALYs) from a healthcare perspective. Clinical inputs were mostly obtained from meta-analysis of landmark trials. All cost-related data, risk of non-cardiovascular death and readmission rate were based on Thai HF data. Costs and QALYs were discounted at 3%. Findings were reported as an incremental cost-effectiveness ratio (ICER). A variety of sensitivity analyses were also performed. RESULTS: CRT plus OMT costs more than OMT (123,279 vs 11,165 THB or 3,972.90 vs 359.81 USD), and is more effective (3.57 QALYs vs 2.49 QALYs), yielding an ICER of 104,325 THB per QALY (3,362.07 USD per QALY). CRT was cost-effective at the Thai willingness to pay threshold of 160,000 THB per QALY (5,156.30 USD per QALY). The results were sensitive to cost of CRT maintenance. CONCLUSION: The use of CRT was associated with a cost-effectiveness ratio below generally accepted benchmarks for therapeutic interventions of 160,000 THB per QALY (5,156.30 USD per QALY). This suggests that the clinical benefits of CRT can be achieved at a reasonable cost in Thai HF patients.
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spelling pubmed-75690462020-10-27 Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand Permsuwan, Unchalee Phrommintikul, Arintaya Silavanich, Voratima Clinicoecon Outcomes Res Original Research BACKGROUND: Cardiac resynchronization therapy (CRT) improves symptoms and survival in patients with heart failure (HF). However, the CRT devices are costly and can impose a significant burden to the relatively constrained health budgets of middle-income countries such as Thailand. The aim of this study was to analyze the cost-effectiveness of CRT in combination with optimal medical therapy (OMT) relative to patients with OMT alone. METHODS: A two-component model was used to analyze lifetime costs and quality-adjusted life-years (QALYs) from a healthcare perspective. Clinical inputs were mostly obtained from meta-analysis of landmark trials. All cost-related data, risk of non-cardiovascular death and readmission rate were based on Thai HF data. Costs and QALYs were discounted at 3%. Findings were reported as an incremental cost-effectiveness ratio (ICER). A variety of sensitivity analyses were also performed. RESULTS: CRT plus OMT costs more than OMT (123,279 vs 11,165 THB or 3,972.90 vs 359.81 USD), and is more effective (3.57 QALYs vs 2.49 QALYs), yielding an ICER of 104,325 THB per QALY (3,362.07 USD per QALY). CRT was cost-effective at the Thai willingness to pay threshold of 160,000 THB per QALY (5,156.30 USD per QALY). The results were sensitive to cost of CRT maintenance. CONCLUSION: The use of CRT was associated with a cost-effectiveness ratio below generally accepted benchmarks for therapeutic interventions of 160,000 THB per QALY (5,156.30 USD per QALY). This suggests that the clinical benefits of CRT can be achieved at a reasonable cost in Thai HF patients. Dove 2020-10-14 /pmc/articles/PMC7569046/ /pubmed/33116697 http://dx.doi.org/10.2147/CEOR.S268553 Text en © 2020 Permsuwan et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Permsuwan, Unchalee
Phrommintikul, Arintaya
Silavanich, Voratima
Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand
title Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand
title_full Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand
title_fullStr Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand
title_full_unstemmed Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand
title_short Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand
title_sort cost-effectiveness of cardiac resynchronization therapy in patients with heart failure in thailand
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569046/
https://www.ncbi.nlm.nih.gov/pubmed/33116697
http://dx.doi.org/10.2147/CEOR.S268553
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