The cost-effectiveness of real-time pulmonary artery pressure monitoring in heart failure patients: a European perspective

Abstract

Aims: Heart failure (HF) treatment guided by physicians with access to real-time pressure measurement from a wireless implantable pulmonary artery pressure (PAP) sensor (CardioMEMS), has previously been shown to reduce HF-related hospital admissions in the CHAMPION trial. However, uncertainty remains regarding the value of CardioMEMS in European health systems where healthcare costs are significantly lower than in the USA. Methods and results: A Markov model was developed to estimate the cost-effectiveness of PAP-guided treatment of HF using the CardioMEMS™ HF system compared with usual care. Cost-effectiveness was measured as the incremental cost per quality-adjusted life year (QALY) gained. In the base case analysis over a time horizon of 10 years, PAP-guided HF therapy increased cost compared with usual care by £10 916 (€14 030). QALYs per patient for usual care and PAP-guided patients were 2.57 and 3.14, respectively, reflecting an increase of 0.57 QALYs with PAP-guided treatment. The resultant incremental cost-effectiveness ratio (ICER) is £19 274 (€24 772) per QALY gained. The base case analysis did not include staff time, due to a lack of data concerning this variable. Running the model with estimated staff time included resulted in an increased ICER of between £22 342 and £25 464 per QALY gained (€28 709–32 721). Conclusion: The analysis indicates that integrating wireless PAP monitoring into the management of UK HF patients is likely to be a cost-effective addition to the HF treatment pathway for appropriate patients.