Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change

Simon Claridge; Frederic A. Sebag; Steven Fearn; Jonathan M. Behar; Bradley Porter; Tom Jackson; Benjamin Sieniewicz; Justin Gould; Jessica Webb; Zhong Chen; Mark O'Neill; Jaswinder Gill; Christophe Leclercq; Christopher A. Rinaldi

doi:10.1136/heartjnl-2017-311749

Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change

Simon Claridge^*, Frederic A. Sebag, Steven Fearn, Jonathan M. Behar, Bradley Porter, Tom Jackson, Benjamin Sieniewicz, Justin Gould, Jessica Webb, Zhong Chen, Mark O'Neill, Jaswinder Gill, Christophe Leclercq, Christopher A. Rinaldi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Objective Responders to cardiac resynchronisation therapy whose device has a defibrillator component and who do not receive a therapy in the lifetime of the first generator have a very low incidence of appropriate therapy after box change. We investigated the cost implications of using a risk stratification tool at the time of generator change resulting in these patients being reimplanted with a resynchronisation pacemaker. Methods A decision tree was created using previously published data which had demonstrated an annualised appropriate defibrillator therapy risk of 2.33%. Costs were calculated at National Health Service (NHS) national tariff rates (2016-2017). EQ-5D utility values were applied to device reimplantations, admissions and mortality data, which were then used to estimate quality-adjusted life-years (QALYs) over 5 years. Results At 5 years, the incremental cost of replacing a resynchronisation defibrillator device with a second resynchronisation defibrillator versus resynchronisation pacemaker was £5045 per patient. Incremental QALY gained was 0.0165 (defibrillator vs pacemaker), resulting in an incremental cost-effectiveness ratio (ICER) of £305 712 per QALYs gained. Probabilistic sensitivity analysis resulted in an ICER of £313 612 (defibrillator vs pacemaker). For reimplantation of all patients with a defibrillator rather than a pacemaker to yield an ICER of less than £30 000 per QALY gained (current NHS cut-off for approval of treatment), the annual arrhythmic event rate would need to be 9.3%. The budget impact of selective replacement was a saving of £2 133 985 per year. Conclusions Implanting low-risk patients with a resynchronisation defibrillator with the same device at the time of generator change is not cost-effective by current NHS criteria. Further research is required to understand the impact of these findings on individual patients at the time of generator change.

Original language	English
Pages (from-to)	416-422
Number of pages	7
Journal	Heart
Volume	104
Issue number	5
Early online date	29 Sept 2017
DOIs	https://doi.org/10.1136/heartjnl-2017-311749
Publication status	Published - 1 Mar 2018

Keywords

Cardiac Resynchronisation Therapy
Cost effectiveness
Defibrillator

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10.1136/heartjnl-2017-311749

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Claridge, S., Sebag, F. A., Fearn, S., Behar, J. M., Porter, B., Jackson, T., Sieniewicz, B., Gould, J., Webb, J., Chen, Z., O'Neill, M., Gill, J., Leclercq, C., & Rinaldi, C. A. (2018). Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change. Heart, 104(5), 416-422. https://doi.org/10.1136/heartjnl-2017-311749

@article{a3a197e0b98940f39be03473c2dd097a,

title = "Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change",

abstract = "Objective Responders to cardiac resynchronisation therapy whose device has a defibrillator component and who do not receive a therapy in the lifetime of the first generator have a very low incidence of appropriate therapy after box change. We investigated the cost implications of using a risk stratification tool at the time of generator change resulting in these patients being reimplanted with a resynchronisation pacemaker. Methods A decision tree was created using previously published data which had demonstrated an annualised appropriate defibrillator therapy risk of 2.33%. Costs were calculated at National Health Service (NHS) national tariff rates (2016-2017). EQ-5D utility values were applied to device reimplantations, admissions and mortality data, which were then used to estimate quality-adjusted life-years (QALYs) over 5 years. Results At 5 years, the incremental cost of replacing a resynchronisation defibrillator device with a second resynchronisation defibrillator versus resynchronisation pacemaker was £5045 per patient. Incremental QALY gained was 0.0165 (defibrillator vs pacemaker), resulting in an incremental cost-effectiveness ratio (ICER) of £305 712 per QALYs gained. Probabilistic sensitivity analysis resulted in an ICER of £313 612 (defibrillator vs pacemaker). For reimplantation of all patients with a defibrillator rather than a pacemaker to yield an ICER of less than £30 000 per QALY gained (current NHS cut-off for approval of treatment), the annual arrhythmic event rate would need to be 9.3%. The budget impact of selective replacement was a saving of £2 133 985 per year. Conclusions Implanting low-risk patients with a resynchronisation defibrillator with the same device at the time of generator change is not cost-effective by current NHS criteria. Further research is required to understand the impact of these findings on individual patients at the time of generator change.",

keywords = "Cardiac Resynchronisation Therapy, Cost effectiveness, Defibrillator",

author = "Simon Claridge and Sebag, {Frederic A.} and Steven Fearn and Behar, {Jonathan M.} and Bradley Porter and Tom Jackson and Benjamin Sieniewicz and Justin Gould and Jessica Webb and Zhong Chen and Mark O'Neill and Jaswinder Gill and Christophe Leclercq and Rinaldi, {Christopher A.}",

year = "2018",

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doi = "10.1136/heartjnl-2017-311749",

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Claridge, S, Sebag, FA, Fearn, S, Behar, JM , Porter, B , Jackson, T , Sieniewicz, B , Gould, J , Webb, J , Chen, Z , O'Neill, M , Gill, J, Leclercq, C & Rinaldi, CA 2018, 'Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change', Heart, vol. 104, no. 5, pp. 416-422. https://doi.org/10.1136/heartjnl-2017-311749

TY - JOUR

T1 - Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change

AU - Claridge, Simon

AU - Sebag, Frederic A.

AU - Fearn, Steven

AU - Behar, Jonathan M.

AU - Porter, Bradley

AU - Jackson, Tom

AU - Sieniewicz, Benjamin

AU - Gould, Justin

AU - Webb, Jessica

AU - Chen, Zhong

AU - O'Neill, Mark

AU - Gill, Jaswinder

AU - Leclercq, Christophe

AU - Rinaldi, Christopher A.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Objective Responders to cardiac resynchronisation therapy whose device has a defibrillator component and who do not receive a therapy in the lifetime of the first generator have a very low incidence of appropriate therapy after box change. We investigated the cost implications of using a risk stratification tool at the time of generator change resulting in these patients being reimplanted with a resynchronisation pacemaker. Methods A decision tree was created using previously published data which had demonstrated an annualised appropriate defibrillator therapy risk of 2.33%. Costs were calculated at National Health Service (NHS) national tariff rates (2016-2017). EQ-5D utility values were applied to device reimplantations, admissions and mortality data, which were then used to estimate quality-adjusted life-years (QALYs) over 5 years. Results At 5 years, the incremental cost of replacing a resynchronisation defibrillator device with a second resynchronisation defibrillator versus resynchronisation pacemaker was £5045 per patient. Incremental QALY gained was 0.0165 (defibrillator vs pacemaker), resulting in an incremental cost-effectiveness ratio (ICER) of £305 712 per QALYs gained. Probabilistic sensitivity analysis resulted in an ICER of £313 612 (defibrillator vs pacemaker). For reimplantation of all patients with a defibrillator rather than a pacemaker to yield an ICER of less than £30 000 per QALY gained (current NHS cut-off for approval of treatment), the annual arrhythmic event rate would need to be 9.3%. The budget impact of selective replacement was a saving of £2 133 985 per year. Conclusions Implanting low-risk patients with a resynchronisation defibrillator with the same device at the time of generator change is not cost-effective by current NHS criteria. Further research is required to understand the impact of these findings on individual patients at the time of generator change.

AB - Objective Responders to cardiac resynchronisation therapy whose device has a defibrillator component and who do not receive a therapy in the lifetime of the first generator have a very low incidence of appropriate therapy after box change. We investigated the cost implications of using a risk stratification tool at the time of generator change resulting in these patients being reimplanted with a resynchronisation pacemaker. Methods A decision tree was created using previously published data which had demonstrated an annualised appropriate defibrillator therapy risk of 2.33%. Costs were calculated at National Health Service (NHS) national tariff rates (2016-2017). EQ-5D utility values were applied to device reimplantations, admissions and mortality data, which were then used to estimate quality-adjusted life-years (QALYs) over 5 years. Results At 5 years, the incremental cost of replacing a resynchronisation defibrillator device with a second resynchronisation defibrillator versus resynchronisation pacemaker was £5045 per patient. Incremental QALY gained was 0.0165 (defibrillator vs pacemaker), resulting in an incremental cost-effectiveness ratio (ICER) of £305 712 per QALYs gained. Probabilistic sensitivity analysis resulted in an ICER of £313 612 (defibrillator vs pacemaker). For reimplantation of all patients with a defibrillator rather than a pacemaker to yield an ICER of less than £30 000 per QALY gained (current NHS cut-off for approval of treatment), the annual arrhythmic event rate would need to be 9.3%. The budget impact of selective replacement was a saving of £2 133 985 per year. Conclusions Implanting low-risk patients with a resynchronisation defibrillator with the same device at the time of generator change is not cost-effective by current NHS criteria. Further research is required to understand the impact of these findings on individual patients at the time of generator change.

KW - Cardiac Resynchronisation Therapy

KW - Cost effectiveness

KW - Defibrillator

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JO - Heart

JF - Heart

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ER -

Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change

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