Heart failure hospitalization reduction and cost savings achieved by improved delivery of effective biventricular pacing: economic implications of the OLE study under the US setting

Figures & data

Figure 1 Markov model structure. Depiction of model structure used for analysis.

Table 1 Base case model parameters

Input parameter	Base case (low, high)	Distribution (parameters*)	Source
Clinical inputs
Pacing related parameters
Probability of AF	0.121 (95% CI: 0.109, 0.132)	Beta (7, 51)	Hernandez-Madrid et al^Citation18
Probability of conduction latency	0.059 (95% CI: 0.051, 0.068)	Beta (3.5, 55.5)	Hernandez-Madrid et al^Citation18
Probability of PVC	0.138 (95% CI: 0.126, 0.15)	Beta (8, 50)	Hernandez-Madrid et al^Citation18
Probability of variable AV nodal conduction	0.042 (95% CI: 0.035, 0.050)	Beta (2.5, 56.5)	Hernandez-Madrid et al^Citation18
Probability of intermittent loss of capture	0.025 (95% CI: 0.020, 0.031)	Beta (1.5, 57.5)	Hernandez-Madrid et al^Citation18
% effective pacing with no pacing disruption	0.951 (95% CI: 0.949, 0.953)	Beta (727.38, 37.68)	Hernandez-Madrid et al^Citation18
Baseline % effective pacing with AF	0.695 (95% CI: 0.598, 0.953)	Beta (0.51, 0.22)	Hernandez-Madrid et al^Citation18
% effective pacing with conduction latency	0.026 (95% CI: 0.0248, 0.027)	Beta (41.55, 1,564.73)	Hernandez-Madrid et al^Citation18
% effective pacing with PVC	0.719 (95% CI: 0.705, 0.733)	Beta (55.3, 21.59)	Hernandez-Madrid et al^Citation18
% effective pacing with variable AV nodal conduction	0.396 (95% CI: 0.379, 0.413)	Beta (25.37, 38.65)	Hernandez-Madrid et al^Citation18
% effective pacing with intermittent loss of capture	0.871 (95% CI: 0.834, 0.908)	Beta (4.62, 0.68)	Hernandez-Madrid et al^Citation18
Healthcare utilization
Baseline hazard of HF hospitalization per month	0.02 (±25%: 0.015, 0.025)	LogNormal (−1.69, 0.02)	Mealing et al^Citation22
Hazard ratio for risk of HF hospitalization associated with each % increase in ventricular pacing	0.977 (95% CI: 0.965, 0.990)	Normal (0.977, 0.04)	Hayes et al^Citation23
Cost inputs (US$)
Cost of a HF hospitalization	$15,770 (±25%: $11,828, $19,213)	Gamma (1.04, 0.0001)	Medicare (2014–2016)

Note: *Parameters: Beta (alpha, beta), lognormal (log (mean), log (standard deviation)) and Gamma (shape, scale).

Table 2 Clinical projections and economic results

Model output	CRT with conventional pacing	CRT with effective pacing	Δ Impact
Mean HF hospitalizations projected per patient over survival time (events)	4.58	2.75	1.83
Cost (Medicare) (US$)	$57,233	$34,431	–$22,802

Figure 2 Tornado diagram (one-way sensitivity analysis; US$). Numbers in brackets represent the lower and upper bounds of the value used for each parameter.

Figure 3 Probabilistic analysis results (US$).

Hernandez-Madrid A, Facchin D, Klepfer RN, et al. Device pacing diagnostics overestimate effective cardiac resynchronization therapy pacing results of the hOLter for Efficacy analysis of CRT (OLE CRT) study. Heart Rhythm. 2017;14:541–547. doi:10.1016/j.hrthm.2017.01.02228104482

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Mealing S, Woods B, Hawkins N, et al. Cost-effectiveness of implantable cardiac devices in patients with systolic heart failure. Heart. 2016;102:1742–1749. doi:10.1136/heartjnl-2015-30888327411837

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Hayes DL, Monteiro JV, Tsintzos SI, Eggington S, Mittal S. Abstract The relationship between percentage left ventricular (LV) pacing and cardiac resynchronization therapy (CRT) outcomes: each percentage matters. Heart Rhythm. 2016;13:S427–S514.

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