Τίτλος:
Economic implications of adding a novel algorithm to optimize cardiac resynchronization therapy: rationale and design of economic analysis for the AdaptResponse trial
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Aims: Although cardiac resynchronization therapy (CRT) has proven beneficial in several randomized trials, a subset of patients have limited clinical improvement. The AdaptivCRT algorithm provides automated selection between synchronized left ventricular or biventricular pacing with optimization of atrioventricular delays. The rationale and design of the economic analysis of the AdaptResponse clinical trial are described. Rationale: The costs associated with HF hospitalization are substantial and are compounded by a high rate of readmission. HF hospitalization payments range from $1,001 for Greece to $12,235 for US private insurance. When examining the breakdown of HF-related costs, it is clear that approximately 55% of the hospitalization costs are directly attributable to length of stay. Notably, the mean costs of a CRT patient in need of a HF-related hospitalization are currently estimated to be an average of $10,679. Methods: The economic analysis of the AdaptResponse trial has two main objectives. The hospital provider objective seeks to test the hypothesis that AdaptivCRT reduces the incidence of all-cause re-admissions after a heart failure admission within 30 days of the index event. A negative binomial regression model will be used to estimate and compare the number of readmissions after an index HF hospitalization. The payer economic objective will assess cost-effectiveness of CRT devices with the AdaptivCRT algorithm relative to traditional CRT programming. This analysis will be conducted from a U.S. payer perspective. A decision analytic model comprised of a 6-month decision tree and a Markov model for long term extrapolation will be used to evaluate lifetime costs and benefits. Conclusion: AdaptivCRT may offer improvements over traditional device programming in patient outcomes. How the data from AdaptResponse will be used to demonstrate if these clinical benefits translate into substantial economic gains is herein described. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Συγγραφείς:
Filippatos, G.
Lu, X.
Tsintzos, S.I.
Gold, M.R.
Mullens, W.
Birnie, D.
Hersi, A.S.
Kusano, K.
Leclercq, C.
Fagan, D.H.
Wilkoff, B.L.
Περιοδικό:
Journal of Medical Economics
Εκδότης:
Taylor and Francis Ltd.
Λέξεις-κλειδιά:
adult; algorithm; Article; cardiac resynchronization therapy; cardiovascular mortality; controlled study; cost effectiveness analysis; Greece; health insurance; heart failure; hospital admission; hospital readmission; hospitalization cost; human; length of stay; major clinical study; practice guideline; quality adjusted life year; randomized controlled trial; sensitivity analysis; algorithm; cardiac resynchronization therapy device; heart failure; treatment outcome, Algorithms; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Heart Failure; Humans; Treatment Outcome
DOI:
10.1080/13696998.2020.1835333
