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Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand

Authors Permsuwan U, Phrommintikul A, Silavanich V

Received 30 June 2020

Accepted for publication 9 September 2020

Published 14 October 2020 Volume 2020:12 Pages 579—588


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Giorgio Lorenzo Colombo

Unchalee Permsuwan,1 Arintaya Phrommintikul,2 Voratima Silavanich1

1Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 2Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

Correspondence: Voratima Silavanich
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Suthep Road, Muang District, Chiang Mai 50200, Thailand
Tel +66 89-430-6510
Fax +66 5-322-2741

Background: Cardiac resynchronization therapy (CRT) improves symptoms and survival in patients with heart failure (HF). However, the CRT devices are costly and can impose a significant burden to the relatively constrained health budgets of middle-income countries such as Thailand. The aim of this study was to analyze the cost-effectiveness of CRT in combination with optimal medical therapy (OMT) relative to patients with OMT alone.
Methods: A two-component model was used to analyze lifetime costs and quality-adjusted life-years (QALYs) from a healthcare perspective. Clinical inputs were mostly obtained from meta-analysis of landmark trials. All cost-related data, risk of non-cardiovascular death and readmission rate were based on Thai HF data. Costs and QALYs were discounted at 3%. Findings were reported as an incremental cost-effectiveness ratio (ICER). A variety of sensitivity analyses were also performed.
Results: CRT plus OMT costs more than OMT (123,279 vs 11,165 THB or 3,972.90 vs 359.81 USD), and is more effective (3.57 QALYs vs 2.49 QALYs), yielding an ICER of 104,325 THB per QALY (3,362.07 USD per QALY). CRT was cost-effective at the Thai willingness to pay threshold of 160,000 THB per QALY (5,156.30 USD per QALY). The results were sensitive to cost of CRT maintenance.
Conclusion: The use of CRT was associated with a cost-effectiveness ratio below generally accepted benchmarks for therapeutic interventions of 160,000 THB per QALY (5,156.30 USD per QALY). This suggests that the clinical benefits of CRT can be achieved at a reasonable cost in Thai HF patients.

Keywords: cost-effectiveness, quality-adjusted life-years, cardiac resynchronization therapy, heart failure, Thailand

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