Economic evaluation of Cardiac Contractility Modulation (CCM) therapy with the optimizer IVs in the management of heart failure patients

• Main Authors: Nikos Maniadakis, Vasilios Fragoulakis, Charalambos Mylonas, Rakesh Sharma, Andrew J Stewart Coats
• Format: Article
• Language: English
• Published: Barcaray International 2015-01-01
• Series: International Cardiovascular Forum Journal
• Subjects: Heart Failure; Cardiac Contractility Modulation; Optimizer; Economic Evaluation; Cost Effectiveness Analysis; Cost Utility Analysis
• Online Access: http://icfjournal.org/index.php/icfj/article/view/173/pdf-2

Aims: Heart failure represents a major burden for health systems and societies. Cardiac contractility modulation (CCM) therapy was developed in recent years for patients with normal QRS in whom optimal pharmacological (OMT) treatment has failed to control symptoms adequately. This study presents an economic evaluation of CCM therapy for the UK. Methods A Markov model was built to simulate the management of patients under two therapy scenarios, on OMT alone and CCM+OMT respectively. The horizon is the patient’s life time and the cycle is 4 weeks. The model estimates life year (LYs), quality adjusted life years (QALYs) and overall treatment costs. Data to populate it came from relevant CCM trials, the literature and other sources. Results The total mean life-time cost was £37,467 in the CCM+OMT arm and £16,885 in the OMT arm. Patients in the OMT arm gained 7.00 LYs and 4.00 QALYs and those on CCM+OMT 7.96 and 5.26 respectively. The incremental cost per QALY was £16,405 and the incremental cost per LY £21,415. Sensitivity analysis indicates that the results are pretty stable and stochastic analysis indicates that at a £30,000 per QALY threshold the likelihood of CCM+OMT being cost-effective is 99.8% and at £25,000 per QALY 97%. Conclusion The present analysis indicates that CCM may be cost-effective therapy. This early conclusion should be viewed in the light of the caveats of the modeling methods used, due to data availability limitations. Long-term studies directly collecting hospitalization and mortality data should be undertaken to provide more robust evidence.