Abstract 16317: Cost-Effectiveness of Bi-Ventricular Pacemakers vs. RV Pacemakers and Bi-Ventricular Defibrillators vs. Dual Chamber Defibrillators in Patients With Atrioventricular Block and Systolic Dysfunction: All-Patient and Subgroup Analyses From the BLOCK-HF Clinical Trial

• Published in: Circulation (New York, N.Y.) N.Y.), 2014-11, Vol.130 (suppl_2)
• Main Authors: Adamson, Philip B, Chung, Eugene S, St. John Sutton, Martin G, Sidhu, Manpreet K, Mealing, Stuart, Padhiar, Amie, Tsintzos, Stelios I, Bril, Sarah L, Lautenbach, Amy A, Curtis, Anne B
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.130.suppl_2.16317

Abstract only BACKGROUND: The cost-effectiveness (C-E) of biventricular (BiV) pacing compared to right ventricular (RV) pacing in patients with a pacing indication due to atrioventricular (AV) block and EF < 50% is unknown. Material differences may exist between the C-E of BiV pacemakers (BiV-P) vs. RV and BiV defibrillators (BiV-D) vs. dual chamber ICDs, the latter when patients independently have an ICD indication. METHODS: Patient-level data from the BLOCK-HF trial were used. Statistical models were used to predict all-cause mortality, NYHA distribution over time, and NYHA-specific HF-related healthcare utilization (HCU) rates. Analyses were undertaken separately for BiV/RV (All-Patient), BiV-P/IPG and BiV-D/ICD. RESULTS: HCU rates in NYHA Classes I/II were lower than Classes III/IV and consistently reduced with BiV devices. Predicted life expectancy in the “All-Patient” analysis was 6.78 years with RV devices and 7.52 with BiV ones (a 10.8% increase). More BiV patients were predicted to remain in, or improve to, Classes I/II, if alive. In the “All-Patient” analysis, BiV offered patients 0.41 more Quality-Adjusted Life Years (QALYs) compared to RV, at an additional cost of $12,537 (Incremental C-E Ratio “ICER” $30,860.16/QALY Gained). Within the clinical co-variate subgroups of the “All-Patient” analysis, the highest ICER observed was $43,687.59 (NYHA Class I Patients). Within the device-based subgroups, BiV-D patients were projected to benefit more (0.84 years gained) than BiV-P ones (0.49 years) CONCLUSIONS: BiV reduces HCU rates compared with RV, offering survival benefits and slowing HF progression. The “All-Patient” ICER was $30,860.16/QALY Gained and ICERs were consistently below the conventional US acceptability threshold ($50,000/QALY Gained). The additional cost associated with offering BiV devices to patients with AV block and systolic dysfunction appears justified by the expected benefits across both device types.