Cost-Effectiveness of Implantable Pulmonary Artery Pressure Monitoring in Chronic Heart Failure

Abstract

Objectives This study aimed to evaluate the cost-effectiveness of the CardioMems device in patients with chronic heart failure. Background The CardioMems device, an implantable pulmonary artery pressure monitor, was shown to reduce heart failure hospitalizations and improve quality of life in the CHAMPION trial. Methods We developed a Markov model to determine the hospitalization, survival, quality of life, cost, and incremental cost-effectiveness ratio of CardioMems implantation compared with usual care among a CHAMPION trial cohort of heart failure patients. We obtained event rates and utilities from published trial data; we used costs from literature estimates and Medicare reimbursement. We performed subgroup analyses of preserved and reduced ejection fraction and an exploratory analysis in a lower-risk cohort based on the CHARM trials. Results CardioMems reduced lifetime hospitalizations (2.18 versus 3.12), increased QALYs (2.74 versus 2.46) and increased costs ($176,648 versus $156,569), yielding a cost of $71,462 per QALY gained and $48,054 per life-year gained. The cost per QALY gained was $82,301 in patients with reduced ejection fraction and $47,768 in those with preserved ejection fraction. In the lower-risk CHARM cohort, the device would need to reduce heart failure hospitalizations by 41% in order to cost less than $100,000 per QALY gained. The cost-effectiveness was most sensitive to the device’s durability. Conclusion In populations similar to the CHAMPION trial, the CardioMems device is cost-effective if the trial effectiveness is sustained over long periods. Post-marketing surveillance data on durability will further clarify its value.

Cost‐Effectiveness of Remote Cardiac Monitoring With theCardioMEMSHeart Failure System

“…The findings from this model are robust and consistent with guidelines on model development and testing that recommend use of real world evidence as much as possible . Our findings generated cost/QALY estimates that differed from 2 recent publications describing models comparing CardioMEMS HF System to usual care, with the present analysis finding a cost/QALY falling between the other publications. Some of these differences are due to the different hospital and outpatient cost inputs utilized.…”

“…The multiple ways in which this model varied utilities to reflect the natural history of disease had little influence on outcomes. A different baseline utility value for patients, such as the 0.55 that another team derived based on an algorithm to convert the Minnesota Living with Heart Failure Questionnaire, also had a small influence on the cost/QALY. It should be noted that some of the sensitivity analysis results are symmetrical around the base case; others are appropriately not symmetrical.…”

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

“…An independent CEA was developed by Sandhu et al 45 that concluded that the CardioMEMS device is cost‐effective with an ICER of US$82 301 in patients with reduced EF and US$47 768 in those with preserved EF. Our analysis produced different estimates of the ICERs for several reasons: first, Sandhu et al used a societal perspective and modelled lifetime costs and effects.…”

Use and Disuse of Observational Research: The Case of Remote Monitoring in Heart Failure

“…Among those performed by independent investigators, one published by the Institute for Clinical and Economic Review found a cost of USD 57,933 per quality-adjusted life year (QALY) gained [31]. Subsequently a cost-effectiveness analysis based on 17-month CardioMEMS follow-up data found a cost of USD 71,462 per QALY gained [32]. Greater cost-effectiveness in HF patients with preserved (>40%) ejection fraction were reported [26], and, as underscored above, all cost-effectiveness results are valuable only for the context in which they have been evaluated.…”