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Cost Effectiveness of Cardiac Resynchronization Therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial

Arthur M. Feldman, MD, PhD, FACC^_*,_*, Gregory de Lissovoy, PhD^,, Michael R. Bristow, MD, PhD, FACC, Leslie A. Saxon, MD, FACC^||, Teresa De Marco, MD, FACC^¶, David A. Kass, MD, FACC, John Boehmer, MD, FACC^#,_**, Steven Singh, MD, FACC^,, David J. Whellan, MD^_*, Peter Carson, MD, FACC^,, Audra Boscoe, MPH, Timothy M. Baker, BS and Matthew R. Gunderman, MBA

^_* Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania
MEDTAP Institute at UBC, Bethesda, Maryland
Department of Health Policy Management, Johns Hopkins School of Public Health, Baltimore, Maryland
Division of Cardiology, University of Colorado, Denver, Colorado
^|| Division of Cardiology, University of Southern California, Los Angeles, California
^¶ Division of Cardiology, University of California, San Francisco, California
^# Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
^_** Division of Cardiology, Hershey Medical Center, Hershey, Pennsylvania
Department of Medicine and Pharmacology at Georgetown University School of Medicine, Washington, DC
Veterans Affairs Medical Center, Washington, DC
Guidant Corporation, St. Paul, Minnesota

View larger version (26K): [in a new window]   Figure 1 Actual survival in the cardiac resynchronization therapy with pacemaker-defibrillator (CRT-D) and cardiac resynchronization therapy with pacemaker (CRT-P) groups over 24 months (dashed line) compared with model survival over seven years based on an exponential survival curve. OPT = optimal pharmacological therapy.

View larger version (50K): [in a new window]   Figure 2 Scatter plot showing cost effectiveness of cardiac resynchronization therapy with pacemaker-defibrillator (CRT-D) relative to optimal pharmacological therapy (OPT) (10,000 model iterations). The horizontal axis depicts incremental gain in (A) life-years (LYSs) or (B) quality-adjusted life-years (QALYs), whereas the vertical axis depicts incremental cost relative to OPT.

View larger version (24K): [in a new window]   Figure 3 Incremental cost effectiveness of cardiac resynchronization therapy with pacemaker-defibrillator (CRT-D) and cardiac resynchronization therapy with pacemaker (CRT-P) as a function of duration of the analyzed episode of treatment. Model base case is seven years (84 months). LYS = life-year; QALY = quality-adjusted life-year.