Presentation (CTI)

OBJECTIVES: To evaluate the cost-effectiveness of the Cordella and CardioMEMS HF systems added to quadruple guideline-directed medical therapy (GDMT) versus GDMT alone in patients with NYHA class II/III heart failure from a U.S. Medicare perspective.
METHODS: We employ a three-state Markov model consisting of stable heart failure, heart failure hospitalization (HFH), and death, over a 5-year time horizon with 1-month cycle lengths. We derive transition probabilities for the Cordella plus GDMT arm from 12-month SIRONA 2 and PROACTIVE-HF trial data, and for the CardioMEMS plus GDMT and GDMT alone arms from both 12-month GUIDE-HF and 30-day CHAMPION trial data, as well as a real-world study of post-HFH outcomes. We discount both costs (measured in 2025 USD) and QALYs at 3% annually, and evaluate resulting ICERs and NMBs using WTP thresholds of $100,000 and $150,000 per QALY. We additionally conduct probabilistic (10,000 Monte Carlo simulations) and deterministic sensitivity analyses.
RESULTS: Over 60 cycles, Cordella plus GDMT yields 3.09 QALYs at $123,031, while CardioMEMS plus GDMT yields 2.63 QALYs at $93,301. GDMT alone yields 2.79 QALYs at $86,391, making Cordella plus GDMT cost-effective versus GDMT alone at a $150,000 WTP threshold (ICER = $126,112/QALY), and cost-effective versus CardioMEMS plus GDMT at both WTP thresholds (ICER = $65,551/QALY). CardioMEMS plus GDMT is dominated by GDMT alone. Probabilistic analyses identify GDMT alone as the most likely cost-effective strategy at either WTP threshold. Key drivers of uncertainty include mortality from stable heart failure and probability of HFH across treatment arms.
CONCLUSIONS: Cordella plus GDMT is cost-effective versus GDMT alone at a WTP threshold of $150,000/QALY, nearly-cost effective versus GDMT alone at a WTP threshold of $100,000/QALY, and cost-effective versus CardioMEMS plus GDMT at either threshold.