• Katia Noyes, Peter Veazie, William Jackson Hall, Hongwei Zhao, April Buttaccio, Kelly Thevenet-Morrison, and Arthur J Moss.
• Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14620, USA. katia_noyes@urmc.rochester.edu
• J. Cardiovasc. Electrophysiol. 2013 Jan 1; 24 (1): 66-74.

BackgroundThe Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) trial demonstrated that cardiac resynchronization therapy (CRT) when added to the implantable cardiac defibrillator (ICD) reduces risk of heart failure or death in minimally symptomatic patients with reduced cardiac ejection fraction and wide QRS complex.ObjectivesTo evaluate 4-year cost-effectiveness of CRT-ICD compared to ICD alone using MADIT-CRT data.Research DesignPatients enrolled in the trial were randomized to implantation of either ICD or CRT-ICD in a 2:3 ratio, with up to 4-year follow-up period. Cost-effectiveness analyses were conducted, and sensitivity analyses by age, gender, and left bundle branch block (LBBB) conduction pattern were performed.SubjectsA total of 1,271 patients with ICD or CRT-ICD (US centers only) who reported healthcare utilization and health-related quality of life data.MeasuresWe used the EQ-5D (US weights) to assess patient HRQOL and translated utilization data to costs using national Medicare reimbursement rates.ResultsAverage 4-year healthcare expenditures in CRT-ICD patients were higher than costs of ICD patients ($62,600 vs 57,050, P = 0.015), mainly due to the device and implant-related costs. The incremental cost-effectiveness ratio of CRT-ICD compared to ICD was $58,330/quality-adjusted life years (QALY) saved. The cost effectiveness improved with longer time horizon and for the LBBB subgroup ($7,320/QALY), with no cost-effectiveness benefit being evident in the non-LBBB group.ConclusionsIn minimally symptomatic patients with low ejection fraction and LBBB, CRT-ICD is cost effective within 4-year horizon when compared to ICD-only.© 2012 Wiley Periodicals, Inc.

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