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. 2020 Oct 14:12:579-588.
doi: 10.2147/CEOR.S268553. eCollection 2020.

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

Unchalee Permsuwan  1 , Arintaya Phrommintikul  2 , Voratima Silavanich  1
Affiliations

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

Unchalee Permsuwan et al. Clinicoecon Outcomes Res. .

Abstract

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.

Keywords: Thailand; cardiac resynchronization therapy; cost-effectiveness; heart failure; quality-adjusted life-years.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Short-term decision tree. (B) Long-term Markov model for optimal medical therapy. (C) Long-term Markov model for cardiac-resynchronization therapy.
Figure 2
Figure 2
Tornado diagram of cardiac resynchronization therapy in combination with optimal medical therapy compared with optimal medical therapy alone.
Figure 3
Figure 3
Scatter plot of probabilistic sensitivity analysis.
Figure 4
Figure 4
Cost-effectiveness acceptability curve of cardiac resynchronization therapy in combination with optimal medical therapy compared with optimal medical therapy alone.
See this image and copyright information in PMC

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