Economic Implications of Response and Non-Response to Cardiac Resynchronization Therapy With Dynamic Atrioventricular Optimization Algorithm Use

Speaker(s)

Ihara Z1, Vincenzi L2, Bozzari I2, Furneri G2, Kellmann T1, Gennaro D1
1Abbott, Zaventem, Flemish Brabant, Belgium, 2Cencora PharmaLex, Milan, Milan, Italy

OBJECTIVES: Cardiac resynchronization therapy (CRT) has been shown to reduce mortality and symptoms in patients experiencing moderate to severe heart failure1. Individual responses to CRT can vary, where non-response leads to poor outcomes and increased healthcare expenditures2. CRT programming is commonly maintained at default settings regardless of individual intrinsic atrioventricular (AV) intervals3. The dynamic AV optimization algorithm aims to improve CRT response by enabling the optimization of the AV delay2. This analysis evaluates the economic implications of algorithm activation in patients treated with CRT in five European countries (France, Germany, Italy, Spain, and UK).

METHODS: The analysis compares two settings over a 3-year horizon. In the first setting, algorithm activation is limited to a small population segment, while in the second setting, algorithm activation is progressively expanded.

The model considered that responders experience fewer HF hospitalizations, office visits, and mortality events versus non-responders4. The respective costs per event were extracted from national DRG tariffs and relevant literature. These were adapted to a weighted average of the five European countries. Notably, there is no additional cost for algorithm activation if the device is already equipped with it.

RESULTS: Considering a hypothetical cohort of 1,000 patients, approximately 30% receive CRT compatible with algorithm activation. AlTurki et al. defined response to CRT as a ≥10% increase in left ventricular ejection fraction which led to response rates as low as 44%, which rose to 71% following algorithm activation5.

Total treatment costs per patient amounted to €4,315 for non-responders and €922 for responders. In the second setting, the increased responder rate attributable to algorithm activation yielded annual cost savings of €82,002 (totaling €246,005 over three years).

CONCLUSIONS: These findings suggest that implementing CRT programming with a dynamic AV optimization algorithm could offer both clinical and economic advantages in the management of HF patients in Europe.

Code

MT56

Topic

Economic Evaluation, Medical Technologies

Topic Subcategory

Budget Impact Analysis, Medical Devices

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory), Medical Devices