Optimisation of cardiac resynchronisation therapy device selection guided by cardiac magnetic resonance imaging: Cost-effectiveness analysis
| Autor: | David Soto-Iglesias, Markus Linhart, Bernhard Fahn, Angelo Auricchio, Laura Sampietro-Colom, Antonio Berruezo, Joan Sagarra, Gabriela Restovic, Carlos Crespo, Juan Acosta, Luis Lasalvia, Artem Boltyenkov, Beatriz Jáuregui, Aurea Mira, M. Martinez |
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| Přispěvatelé: | University of Zurich, Berruezo, Antonio |
| Rok vydání: | 2019 |
| Předmět: |
Male
Time Factors Epidemiology Cost effectiveness Cost-Benefit Analysis 030204 cardiovascular system & hematology law.invention Cardiac Resynchronization Therapy 0302 clinical medicine law 030212 general & internal medicine medicine.diagnostic_test Health Care Costs Cost-effectiveness analysis Middle Aged Prognosis Magnetic Resonance Imaging Markov Chains Observational Studies as Topic Models Economic Cardiology Female Quality-Adjusted Life Years Cardiology and Cardiovascular Medicine Algorithms medicine.medical_specialty Clinical Decision-Making 610 Medicine & health 11171 Cardiocentro Ticino 2705 Cardiology and Cardiovascular Medicine Decision Support Techniques Implantable defibrillators 03 medical and health sciences Life Expectancy Predictive Value of Tests Cardiac magnetic resonance imaging Internal medicine medicine Humans Cardiac Resynchronization Therapy Devices Selection (genetic algorithm) Aged Retrospective Studies Heart Failure business.industry Patient Selection medicine.disease Quality-adjusted life year Heart failure Quality of Life Artificial cardiac pacemaker business 2713 Epidemiology |
| Zdroj: | European Journal of Preventive Cardiology. 27:622-632 |
| ISSN: | 2047-4881 2047-4873 |
| DOI: | 10.1177/2047487319873149 |
| Popis: | Background A recent study showed that the presence and characteristics of myocardial scar could independently predict appropriate implantable cardioverter-defibrillator therapies and the risk of sudden cardiac death in patients receiving a de novo cardiac resynchronisation device. Design The aim was to evaluate the cost-effectiveness of cardiac magnetic resonance imaging-based algorithms versus clinical practice in the decision-making process for the implantation of a cardiac resynchronisation device pacemaker versus cardiac resynchronisation device implantable cardioverter-defibrillator device in heart failure patients with indication for cardiac resynchronisation therapy. Methods An incidental Markov model was developed to simulate the lifetime progression of a heart failure patient cohort. Key health variables included in the model were New York Heart Association functional class, hospitalisations, sudden cardiac death and total mortality. The analysis was done from the healthcare system perspective. Costs (€2017), survival and quality-adjusted life years were assessed. Results At 5-year follow-up, algorithm I reduced mortality by 39% in patients with a cardiac resynchronisation device pacemaker who were underprotected due to misclassification by clinical protocol. This approach had the highest quality-adjusted life years (algorithm I 3.257 quality-adjusted life years; algorithm II 3.196 quality-adjusted life years; clinical protocol 3.167 quality-adjusted life years) and the lowest lifetime costs per patient (€20,960, €22,319 and €28,447, respectively). Algorithm I would improve results for three subgroups: non-ischaemic, New York Heart Association class III–IV and ≥65 years old. Furthermore, implementing this approach could generate an estimated €702 million in health system savings annually in European Society of Cardiology countries. Conclusion The application of cardiac magnetic resonance imaging-based algorithms could improve survival and quality-adjusted life years at a lower cost than current clinical practice (dominant strategy) used for assigning cardiac resynchronisation device pacemakers and cardiac resynchronisation device implantable cardioverter-defibrillators to heart failure patients. |
| Databáze: | OpenAIRE |
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