Table 1.
Base-Case Model Parameters
| Parameter | CRT-D | ICD | References |
|---|---|---|---|
| Patient age, y | 65 | 65 | 11, 12 |
| Device implantation, % | |||
| Procedural success | 94 | 100 | 13 |
| Implant complication* | 5 | 3 | 24 |
| Procedural death | 0.3 | 0.2 | 24 |
| Efficacy | |||
| Mortality (risk ratio, CRT-D vs. ICD)† | 0.80 | - | 13 |
| Hospitalization (risk ratio, CRT-D vs. ICD) | 0.69 | - | 12, 13 |
| Mortality | |||
| Baseline riskfor cardiac death‡ | 0.0037 | 0.0037 | 12 |
| Device complications | |||
| Lead failure‡ | 0.0022 | 0.0015 | 25 |
| Lead infection‡ | 0.0007 | 0.0007 | 25–28 |
| Death from lead failure‡ | 0.013 | 0.013 | 29 |
| Death from lead infection‡ | 0.05 | 0.05 | 27, 30 |
| Length of lead failure hospitalization, d | 2 | 2 | Expert opinion |
| Length of lead infection hospitalization, d | 5 | 5 | CMS |
| Battery life, y | 4 | 5 | 31 |
| Heart failure events | |||
| Baseline hospitalization‡ | 0.006 | 0.008 | 11, 12 |
| Subsequent hospitalization‡ | 0.06 | 0.06 | 23 |
| Death afterheart failure hospitalization‡ | 0.05 | 0.05 | 23 |
| Length of heart failure hospitalization, d | 5 | 5 | CMS |
| Device costs, $ | |||
| Implantation without complication | 40 892 | 33 323 | CMS |
| Implantation with complication | 49 418 | 41 850 | CMS |
| Failed CRT-D implantation | 33 892 | - | CMS |
| Lead failure | 16 425 | 16 361 | CMS |
| Lead infection | 49 149 | 40 812 | CMS |
| Generator change | 34 902 | 27 884 | CMS |
| Heart failure costs, $ | |||
| Heart failure hospitalization | 6227 | 6227 | CMS |
| Heart failure background costs | 1298/mo | 1298/mo | CMS, 32, 33 |
| Utilities | |||
| Baseline | 0.884 | 0.874 | 15 |
| Decrement for age75yorolder | Baseline × 0.931 | Baseline × 0.931 | 34 |
| Decrement forheart failure hospitalization | Baseline × 0.828for7 d§, followed by 0 for 5 d | Baseline × 0.828 for 7 d§, followed by 0 for 5 d | 19, 35 |
| Decrement for lead failure | 0 for 2 d | 0 for 2 d | 19 |
| Decrement for lead infection | 0 for 5 d | 0 for 5 d | 19 |
CMS = Centers for Medicare & Medicaid Services;CRT-D = cardiac resynchronization therapy combined with an implantable cardioverter-defibrillator; ICD = implantable cardioverter-defibrillator.
*
Defined as pneumothorax, hematoma, and complications related to the coronary sinus.
†
Corresponding to a derived risk ratio (applied to cardiac death only) of 0.69.
‡
Indicates unit in monthly probability terms.
§
Corresponding to a drop to New York Heart Association class III symptoms.