Objective: To evaluate the cost-effectiveness of combined resynchronisation and implantable defibrillator therapy for left ventricular dysfunction and explore subgroups in which such devices might be most cost-effective.
Design: Markov model-based economic evaluation.
Setting: UK NHS.
Participants: A simulated mixed age cohort of NYHA class III and IV patients with left ventricular systolic dysfunction and prolonged QRS interval.
Main outcome measures: Cost per quality adjusted life year gained over the patient lifetime.
Results: The incremental cost-effectiveness of resynchronisation therapy alone compared with optimal medical therapy was pound16,735 (95% CI: pound14,630 to pound20,333) with a 91% probability of being cost-effective at a willingness to pay threshold of pound30,000. Compared with resynchronisation alone, the incremental cost-effectiveness of combined implantable defibrillator was pound40,160 (95% CI: pound26,645 to pound59,391) with only a 26% probability of cost-effectiveness at the pound30,000 threshold. In a direct comparison across three treatments (medical treatment, resynchronisation alone and combined resynchronisation with implantable defibrillator therapy) resynchronisation alone was found to be the most cost-effective option.
Conclusion: Combined resynchronisation and implantable defibrillator therapy is not cost-effective for left ventricular dysfunction. Instead resynchronisation alone remains the most cost-effective policy option in this population. Combined devices are more likely to be cost-effective in the subgroups of younger patients or those with high risk of sudden cardiac death who would qualify for resynchronisation therapy.