182Comprehensive economic analysis of automatic optimization algorithms in cardiac resynchronization defibrillators (CRT-Ds): Markov modelling under the Italian, Spanish and UK healthcare settings

Abstract

Background: Innovative algorithms have recently been integrated in Cardiac Resynchronization Therapy (CRT) devices, with and without a defibrillator, and allow automated ambulatory re-programming and appropriate withholding of right ventricular (RV) pacing. Initial economic work has shown the potential of these "adaptive" algorithms to realise better patient outcomes via increased response to therapy and reductions in the need of periodic ultrasound-driven device optimization. Recent evidence suggests the previously reported economic benefits may underestimate the true value of these technologies based on new clinical evidence of reduction in the risk of Atrial Fibrillation and readmission after a Heart Failure (HF) hospitalization. Furthermore, updated algorithms in the generator increase generator longevity and reduce patient risk and costs associated with device change-outs. Purpose(s): Evaluate the holistic economic benefit of adaptive CRT optimization algorithms under a variety of European healthcare delivery settings (Italy, Spain and the United Kingdom). Method(s): Markov Modelling from 6-months post-CRT implant to patient lifetime, informed by empirical data for 0-6 months. Diagnosis-Related Groupings, applicable for each country setting studied, were used for all types of cost estimation. Published clinical data were used to inform impact of adaptive algorithms to response, hospitalization, and mortality risk. Response was assessed via the Clinical Composite Score (CCS) that was in turn associated with varying risks of mortality and HF hospitalisation. Healthcare utility of NYHA Functional Class III was based on the literature. CRTD clinical and economic data were used. Result(s): Healthcare utility accumulation was equal to 7.09 Quality Adjusted Life Years (QALYs) with adaptive algorithms and 6.79 without (+0.3 in favour of novel devices). Without accounting for generator longevity benefits, patients with adaptive CRT algorithms average costs per patient were modelled to cost e28,113.00, e29,618.89 and e29,425.37 (25,454.47) per lifetime (what unit time) for Italy, Spain and the United Kingdom respectively. Traditional device average lifetime costs per patient were modelled to be 29,215.16, 30,833.93 and 30,273.19 (26,274.39) (1=1.156). Conclusion(s): The use of adaptive algorithms was projected to offer better qualityadjusted patient survival while avoiding costs under all studied healthcare delivery settings. (Figure Presented).