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

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.