Valutazione economica della resincronizzazione cardiaca nei pazienti affetti da scompenso cardiaco moderato-avanzato (original) (raw)

2003, PharmacoEconomics Italian Research Articles

Biventricular resynchronization in heart failure: analysis of hospital costs and clinical effectiveness Objective: Patients with severe heart failure, refractory to drug treatment, can be indicated for biventricular pacing, shown to be useful in overcoming the desynchronization of the ventricular contraction pattern, which generally worsens the hemodynamic conditions of such patients. This study was aimed at assessing 1) clinical effectiveness of conventional therapy compared with biventricular pacemaker; 2) hospital ward's budget before and after device implantation. Methods: The study was carried out according to an observational method, on 30 patients, retrospectively 1-year before implantation and prospectively 1-year afterwards. The economic analysis was designed and carried out in the hospital perspective. End-points were: Ejection fraction, New York Heart Association (NYHA) class, no. of hospitalizations in Cardiology Ward and ICU (Intensive Care Unit), Days of hospitalization in Cardiology Ward and ICU, no. of clinic visits (outpatients), no. of day-hospital visits, no. of days free from acute events requiring hospitalization or clinic visits, health care costs. Results: In the 12 months following biventricular pacing, patients showed: a reduction in functional NYHA class (3.0 ± 0.3 vs 2.1 ± 0.3); a reduction in cardiovascular related hospital stays (from 42.0 ± 37.5 days to 2.8 ± 6.4); an increase in number of days free from acute events (from 104 ± 123 to 266 ± 137). Overall costs decreased from € 383,518 to € 289,890 (with implant costs) and to € 58,549 (without implant costs). In-hospital stays in Cardiology and Coronary Unit decreased by 93% and 95%, respectively. Conclusions: Biventricular pacing in heart failure patients represents an efficient approach in the hospital perspective and allows a less intensive use of clinical resources. Even if other non-hospital-sustained costs are not taken into Summary 12 Curnis et al.