Economic Evaluation of A Dedicated Cardiac Resynchronisation Therapy Pre-Assessment Clinic

TY - JOUR

T1 - Economic Evaluation of A Dedicated Cardiac Resynchronisation Therapy Pre-Assessment Clinic

AU - Sidhu, Baldeep

AU - Rua, Tiago

AU - Gould, Justin

AU - Porter, Bradley

AU - Sieniewicz, Benjamin

AU - Niederer, Steven

AU - Rinaldi, Christopher Aldo

AU - Carr-White, Gerald

PY - 2020/5/20

Y1 - 2020/5/20

N2 - Introduction: Patient evaluation before cardiac resynchronisation therapy (CRT) remains heterogenous across centres and it’s suspected a proportion of patients with unfavourable characteristics proceed to implantation. We developed a unique CRT pre-assessment clinic (CRT PAC) to act as a final review for patients already considered for CRT. We hypothesised this clinic would identify some patients unsuitable for CRT through updated review and investigations. The purpose of this analysis was to determine whether the CRT PAC led to savings for the National Health Service (NHS).Methods: A decision tree model was made to evaluate two clinical pathways; (1) standard of care where all patients initially seen in an outpatient cardiology clinic proceeded directly to CRT and (2) management of patients in CRT PAC. Results: 244 patients were reviewed in the CRT PAC; 184 patients were eligible to proceed directly for implantation and 48 patients did not meet consensus guidelines for CRT so were not implanted. Following CRT, 82.4% of patients had improvement in their clinical composite score and 57.7% had improvement in left ventricular end-systolic volume ≥15%. Using the decision tree model, by reviewing patients in the CRT PAC the total savings for the NHS was £966,880. Taking into consideration the additional cost of the clinic and by applying this model structure throughout the NHS the potential savings could be as much as £39 million. Conclusions: CRT PAC appropriately select patients and leads to substantial savings for the NHS. Adopting this clinic across the NHS has the potential to save £39 million.

AB - Introduction: Patient evaluation before cardiac resynchronisation therapy (CRT) remains heterogenous across centres and it’s suspected a proportion of patients with unfavourable characteristics proceed to implantation. We developed a unique CRT pre-assessment clinic (CRT PAC) to act as a final review for patients already considered for CRT. We hypothesised this clinic would identify some patients unsuitable for CRT through updated review and investigations. The purpose of this analysis was to determine whether the CRT PAC led to savings for the National Health Service (NHS).Methods: A decision tree model was made to evaluate two clinical pathways; (1) standard of care where all patients initially seen in an outpatient cardiology clinic proceeded directly to CRT and (2) management of patients in CRT PAC. Results: 244 patients were reviewed in the CRT PAC; 184 patients were eligible to proceed directly for implantation and 48 patients did not meet consensus guidelines for CRT so were not implanted. Following CRT, 82.4% of patients had improvement in their clinical composite score and 57.7% had improvement in left ventricular end-systolic volume ≥15%. Using the decision tree model, by reviewing patients in the CRT PAC the total savings for the NHS was £966,880. Taking into consideration the additional cost of the clinic and by applying this model structure throughout the NHS the potential savings could be as much as £39 million. Conclusions: CRT PAC appropriately select patients and leads to substantial savings for the NHS. Adopting this clinic across the NHS has the potential to save £39 million.

KW - Pacemaker

KW - Heart Failure with reduced ejection fraction

KW - Health care delivery

KW - Health care economics

M3 - Article

SN - 2053-3624

JO - Open Heart

JF - Open Heart

ER -