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Biventricular pacing cost-effective for patients with atrioventricular block, left ventricular dysfunction
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LAS VEGAS — Treatment with biventricular pacing is cost-effective for patients with left-ventricular dysfunction and symptomatic atrioventricular block, according to an economic analysis of the BLOCK-HF trial presented at the Heart Failure Society of America Annual Scientific Meeting.
In the double blind BLOCK-HF trial, patients with LV dysfunction (ejection fraction <50%) and high-grade, symptomatic atrioventricular block were randomly assigned to undergo biventricular pacing with cardiac resynchronization therapy or right ventricular pacing only. Primary endpoints included all-cause mortality, urgent care related to HF requiring IV therapy and an increase of ≥15% in LV end-systolic volume index. Results from the overall trial indicated a 27% relative risk reduction in the primary endpoint with biventricular pacing compared with control therapy (HR=0.74; 95% CI; 0.59-0.93).
The current analysis assessed the cost-effectiveness of biventricular pacing in this patient population. The economic analysis focused on the incidence of HF-related hospitalization, ED visits and clinic visits. The majority of patients were expected to be Medicare recipients.
The researchers projected that biventricular pacing would yield a 10.8% increase in survival rate, with a discounted life expectancy of 7.52 years in the biventricular pacing group and 6.78 years in the right ventricular pacing group.
Use of HF-related resources was projected to decrease with biventricular pacing across a number of groups: HF-related hospitalizations were estimated to decrease by 8.64% to 8.72% according to NYHA class; HF-related ED visits by 30.57% to 30.73%; and HF-related clinic visits from 25.64% to 25.71%.
Philip B. Adamson
Patients assigned biventricular pacing gained an estimated 4.73 quality-adjusted life years, compared with 4.33 in the right ventricular group, with a total cost per-patient of $52,804.64 and $40,267.64, respectively. The researchers noted an incremental cost-effectiveness ratio of $30,860 per quality-adjusted life year gained — below the US acceptability threshold of $50,000 per quality-adjusted life year.
“After taking into consideration a tremendous amount of clinical variables, including an extrapolation out to a 10-year predicted survival, we found that the incremental cost of using a biventricular pacemaker in this population was … well within the economic framework of interventions used in medicine,” Philip B. Adamson, MD, MSc, director of the heart failure program at Oklahoma Heart Hospital in Oklahoma City, told Cardiology Today. “… Our analysis demonstrated that it is cost-effective to provide this therapy for our patients — to prolong their life and improve their quality of life.”
For more information:
Adamson PB. Abstract #319. Presented at: the Heart Failure Society of American Annual Scientific Meeting; Sept. 14-17, 2014; Las Vegas.
Disclosure: The BLOCK-HF trial was funded by Medtronic. Adamson reports receiving consultant fees from Boston Scientific, CardioMEMS, Medtronic and St. Jude Medical.