Reply to: “CardioMEMS in HF patients: study confirms benefit in costs and QALYs, but does not measure QALYs”

We thank the authors of the letter for their interest and commentary regarding our study titled ‘Cost‐Benefit Analysis of the CardioMEMS HF System in a Heart Failure Clinic in Spain’. ¹ , ²

We acknowledge the points raised concerning the quality‐adjusted life years (QALYs) and appreciate the opportunity to address these aspects.

The omission of directly measured QALYs in our study is indeed a limitation we recognize; ideally, direct measurement would provide additional robustness to our findings. We were faced with the challenge of not having a control group, which is compounded by the potential placebo effect inherent in interventions such as the implantation of a pulmonary artery pressure sensor. This complexity is recognized and presents a known difficulty in assessing the true impact on the patients' quality of life.

To address this limitation, our study included a sensitivity analysis (Supporting Information, Table S2 and Figure S1), which was designed to explore the robustness of our conclusions by assessing how variations in the QALY benefit could influence the outcomes. This analysis aimed to approximate the potential effects on quality of life in the absence of direct measurement.

It is noteworthy to mention that the CHAMPION trial found the CardioMEMS implant to confer a benefit of 0.3 QALY for the patient; this was adopted as an effectiveness benchmark for our analysis. However, when compared with the mean and median benefits reported in other studies—0.42 and 0.39 QALY, respectively (Supporting Information, Table S1)—our benchmark may be seen as conservative. This suggests that the actual benefit could potentially be greater than what we have posited, implying that the benefit–cost ratio of the CardioMEMS HF system may be more favourable than reported in our initial findings.

Finally, it is essential to emphasize that the reduction in hospitalizations for heart failure and the associated improvement in QALYs reported in previous randomized studies provide substantial evidence of a positive impact on patients' quality of life. ³ , ⁴

To negate the benefit in quality of life conferred by the CardioMEMS system, especially given the well‐documented burden of heart failure hospitalization, would not reflect the realities of patient experience.

Codina, P. , López‐Seguí, F. , and Bayés‐Genís, A. (2024) Reply to: “CardioMEMS in HF patients: study confirms benefit in costs and QALYs, but does not measure QALYs”. ESC Heart Failure, 11: 2475. 10.1002/ehf2.14820.