![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
Abstract
Aims: The Biventricular vs Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK-HF) demonstrated that biventricular (BiV) pacing resulted in better clinical and structural outcomes compared to right ventricular (RV) pacing in patients with atrioventricular (AV) block and reduced left ventricular ejection fraction (LVEF; ≤50%). This study investigated the cost-effectiveness of BiV vs RV pacing in the patient population enrolled in the BLOCK-HF trial.
Methods: All-cause mortality, New York Heart Association (NYHA) Class distribution over time, and NYHA-specific heart failure (HF)-related healthcare utilization rates were predicted using statistical models based on BLOCK-HF patient data. A proportion-in-state model calculated cost-effectiveness from the Medicare payer perspective.
Results: The predicted patient survival was 6.78 years with RV and 7.52 years with BiV pacing, a 10.9% increase over lifetime. BiV pacing resulted in 0.41 more quality-adjusted life years (QALYs) compared to RV pacing, at an additional cost of $12,537. The “base-case” incremental cost-effectiveness ratio (ICER) was $30,860/QALY gained. Within the clinical sub-groups, the highest observed ICER was $43,687 (NYHA Class I). Patients receiving combined BiV pacing and defibrillation (BiV-D) devices were projected to benefit more (0.84 years gained) than BiV pacemaker (BiV-P) recipients (0.49 years gained), compared to dual-chamber pacemakers.
Conclusions: BiV pacing in AV block patients improves survival and attenuates HF progression compared to RV pacing. ICERs were consistently below the US acceptability threshold ($50,000/QALY). From a US Medicare perspective, the additional up-front cost associated with offering BiV pacing to the BLOCK-HF patient population appears justified.
Transparency
Declaration of funding
The BLOCK-HF trial was funded in its entirety by Medtronic plc. ICON/Oxford Outcomes was commissioned by Medtronic to conduct this analysis. Medtronic played no role in the actual analyses apart from providing directional and explanatory input when needed.
Declaration of financial/other relationships
ESC has received consulting fees from Medtronic plc and Boston Scientific Corporation. MGSJS has no financial or other relationships to declare. SM, MKS, and AP are employees of ICON/Oxford Outcomes. SIT is an employee of, and owns shares in, Medtronic plc. XL, KLPV, and AAL are employees of Medtronic plc. ABC has received consulting fees from Medtronic plc, honoraria from Medtronic plc and St. Jude Medical Inc., and participates in a St. Jude Medical Inc. Advisory Board. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgements
No assistance in the preparation of this article is to be declared.