Cost-effectiveness analyses to assess the value of reactive atrial-based anti-tachycardia pacing for patients with pacemakers and defibrillators: An Australian private healthcare system perspective.

Background: Cardiac implantable electronic devices (CIED) with reactive atrial-based anti-tachycardia pacing (rATP) have been developed to stop the progression of atrial fibrillation (AF), a frequently occurring arrhythmia. This study assessed the value of rATP from the Australian private healthcare payer perspective. Methods: A Markov state-transition model, including bradycardia, stroke, heart failure (HF), and death, was used to evaluate the value of rATP in conjunction with either pacemakers (PM), implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy pacemakers (CRT-P), or CRT defibrillators (CRT-D). It was assumed that PM patients have bradycardia with no AF, and other patients have mild HF at insertion. Efficacy inputs, battery life, and device costs varied between devices. Conservatively, outpatient/follow-up costs of stroke and HF were excluded. All analyses were conducted using a cost-effectiveness threshold of 50 000 Australian dollars (A$) per quality-adjusted life year (QALY) gained, and deterministic sensitivity analysis was performed on key inputs. Results: Using a 30-year horizon and a 5% discount rate, rATP was cost-effective up to a value of A$5609 (PM), A$11 628 (CRT-D), A$14 142 (CRT-P), and A$17 858 (ICD). In sensitivity analysis, varying patient age, rATP efficacy, HF and stroke mortality, stroke recurrence risk, utility values, time horizon, battery life, and the discount rate, the value of rATP ranged from A$3122 to A$11 375 (PM), A$1455 to A$26 409 (ICD), A$1171 to A$20 674 (CRT-P), and A$973 to A$16 907 (CRT-D). Conclusion: Reactive ATP provides clinical benefits to patients who require a CIED. These benefits justify a value premium for devices with rATP functionality.