Cost-Effectiveness Ratio Analysis of LBBaP Versus BVP in Heart Failure Patients With LBBB.

IF 1.7 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pace-Pacing and Clinical Electrophysiology Pub Date : 2024-11-01 Epub Date: 2024-09-28 DOI:10.1111/pace.15077

Shengchan Wang, Siyuan Xue, Zhixin Jiang, Xiaofeng Hou, Fengwei Zou, Wen Yang, Xiujuan Zhou, Shigeng Zhang, Jiangang Zou, Qijun Shan

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Abstract

Background: For the initial treatment strategy for patients with cardiac resynchronization therapy (CRT) indications, whether to choose left bundle branch area pacing (LBBaP) or biventricular pacing (BVP) remains controversial. We aimed to investigate the cost-effectiveness ratio (CER) of LBBaP and BVP in heart failure (HF) patients with left bundle branch block (LBBB).

Methods: This observational study included HF patients with LBBB who underwent successful LBBaP or BVP. The primary outcomes were echocardiographic response (left ventricular ejection fraction [LVEF] increase ≥5%), LVEF improvement, hospitalization costs, and CER (CER = cost/echocardiographic response rate). Secondary outcomes included other echocardiographic parameters, New York Heart Association (NYHA), N-terminal pro-B-type natriuretic peptide (NT-proBNP), pacemaker parameters, complications, ventricular arrhythmia (VA) events, HF hospitalization (HFH), and all-cause mortality.

Results: A total of 130 patients (85 LBBaP and 45 BVP) were included (65.6 ± 10.0 years, 70.77% men). The median follow-up period was 16(12,30), months. Compared with BVP, the LBBaP group showed a greater increase in LVEF (20.2% ± 11.8% vs. 10.5% ± 13.9%; p < 0.001), higher echocardiographic response rate (86.1% vs. 57.8%; p < 0.001), and lower hospitalization costs [$9707.7 (7751.2, 18,088.5) vs. $20,046.1 (18,840.1, 22,447.3); p < 0.0001]. The CER was 112.7 and 346.8 in LBBaP and BVP, respectively. The incremental cost-effectiveness ratio (ICER = △cost/△echocardiographic response rate) was $-365.3/per 1% increase in effectiveness. LBBaP improved cardiac function more significantly than BVP. There were no significant differences in clinical outcomes.

Conclusions: LBBaP-CRT is more cost-effective than BVP, offering greater LVEF improvement, higher echocardiographic response rates, lower hospitalization costs, and more significantly improved cardiac function. These findings need large randomized clinical trials for further confirmation.

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LBBaP与BVP治疗LBBB心衰患者的成本效益比分析

背景：对于心脏再同步治疗（CRT）适应症患者的初始治疗策略，是选择左束支区起搏（LBBaP）还是双心室起搏（BVP）仍存在争议。我们旨在研究左束支传导阻滞（LBBB）的心力衰竭（HF）患者使用 LBBaP 和 BVP 的成本效益比（CER）：这项观察性研究纳入了成功接受 LBBaP 或 BVP 的 LBBBH 患者。主要结果是超声心动图反应（左室射血分数[LVEF]增加≥5%）、LVEF改善、住院费用和CER（CER = 费用/超声心动图反应率）。次要结果包括其他超声心动图参数、纽约心脏协会（NYHA）、N末端前B型钠尿肽（NT-proBNP）、起搏器参数、并发症、室性心律失常（VA）事件、高频住院（HFH）和全因死亡率：共纳入 130 名患者（85 名 LBBaP 患者和 45 名 BVP 患者）（65.6 ± 10.0 岁，70.77% 为男性）。中位随访时间为 16（12,30）个月。与 BVP 相比，LBBaP 组的 LVEF 增加幅度更大（20.2% ± 11.8% vs. 10.5% ± 13.9%；P 结论：LBBaP-CRT 比 BVP 组的 LVEF 增加幅度更大（20.2% ± 11.8% vs. 10.5% ± 13.9%）：与 BVP 相比，LBBaP-CRT 更具成本效益，LVEF 改善幅度更大，超声心动图反应率更高，住院费用更低，心功能改善更显著。这些发现需要大型随机临床试验进一步证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pace-Pacing and Clinical Electrophysiology 医学-工程：生物医学

CiteScore

2.70

自引率

5.60%

发文量

209

审稿时长

2-4 weeks

期刊介绍： Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.

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