A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

F. Tomini*, F. Prinzen, A. D. I. van Asselt

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

7 Citations (Web of Science)


Objectives Cardiac resynchronization therapy with a biventricular pacemaker (CRT-P) is an effective treatment for dyssynchronous heart failure (DHF). Adding an implantable cardioverter defibrillator (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, if the majority of patients do not require shock therapy, the cost-effectiveness ratio of CRT-D compared to CRT-P may be high. The objective of this study was to systematically review decision models evaluating the cost-effectiveness of CRT-D for patients with DHF, compare the structure and inputs of these models and identify the main factors influencing the ICERs for CRT-D. Methods A comprehensive search strategy of Medline (Ovid), Embase (Ovid) and EconLit identified eight cost-effectiveness models evaluating CRT-D against optimal pharmacological therapy (OPT) and/or CRT-P. Results The selected economic studies differed in terms of model structure, treatment path, time horizons, and sources of efficacy data. CRT-D was found cost-effective when compared to OPT but its cost-effectiveness became questionable when compared to CRT-P. Conclusions Cost-effectiveness of CRT-D may increase depending on improvement of all-cause mortality rates and HF mortality rates in patients who receive CRT-D, costs of the device, and battery life. In particular, future studies need to investigate longer-term mortality rates and identify CRT-P patients that will gain the most, in terms of life expectancy, from being treated with a CRT-D.
Original languageEnglish
Pages (from-to)1159-1172
JournalEuropean Journal of Health Economics
Issue number9
Publication statusPublished - Dec 2016


  • Review
  • Cost-effectiveness
  • Cardiac resynchronization therapy
  • Cardiac pacing
  • Implantable cardioverter-defibrillator
  • Markov chains
  • Models
  • Economic
  • Heart failure
  • Sudden cardiac death

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