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European Journal of Heart Failure 2008 10(9):869-877; doi:10.1016/j.ejheart.2008.06.018
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© 2008 European Society of Cardiology

Cost effectiveness of cardiac resynchronization therapy in the Nordic region: An analysis based on the CARE-HF trial

P. Blomströma,*, M. Ekmanb, C. Blomström Lundqvista, M.J. Calvertc, N. Freemantlec, S. Lönnerholma, G. Wikströma and B; Jönssond

a Department of Cardiology, University Hospital in Uppsala Stockholm, Sweden
b European Health Economics Stockholm, Sweden
c Department of Primary Care and General Practice, University of Birmingham Edgbaston, Birmingham, Uk
d Stockholm School of Economics Stockholm, Sweden

* Corresponding author. Department of Cardiology, University Hospital in Uppsala, SE-751 85 Uppsala, Sweden. Tel.: +46 18 611 3142. E-mail address: per.blomstrom{at}akademiska.se (P. Blomström).


  Abstract

Background: The aim of this study was to investigate the cost-effectiveness of cardiac resynchronization therapy (CRT) in Denmark, Finland and Sweden. The analysis was based on the CARE-HF trial, a randomised clinical trial investigating the efficacy of adding CRT (n=409) to optimal pharmacological treatment (n=404) in patients with moderate to severe heart failure with markers of cardiac dyssynchrony. The average follow-up time was 29.4 months.

Methods: The health effects were measured in terms of quality-adjusted life years (QALYs) gained. Data on health care resource consumption from CARE-HF was combined with costs for CRT implantation and hospitalisation from university hospitals in Denmark, Finland and Sweden. Calculations were based on patients' expected life time. The expected device lifetime (6 years) was used for CRT, and no additional gains in clinical effects were assumed after the 6 years.

Results: The cost-effectiveness ratio per QALY gained was {euro} 4800 in Denmark, {euro} 3600 in Finland and {euro} 6700 in Sweden. The 95% confidence intervals for the cost per QALY gained varied between a lower limit of {euro} 1169 in Finland to an upper limit of {euro} 17,482 in Sweden. These values were all below the threshold for being cost-effective in Denmark, Finland and Sweden.

Conclusion: The study indicates that CRT is a cost-effective treatment in Scandinavian health care settings compared to traditional pharmacological therapy and can therefore be recommended for routine use in patients with moderate to severe heart failure and markers of dyssynchrony.

Key Words: Cost-effectiveness analysis • Exonomic evaluation • Heart failure • Cardiac resynchronization therapy • CARE-HF

Received December 5, 2007; Revised May 28, 2008; Accepted June 30, 2008


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