Multipoint Pacing Reduces Predicted Health Care Costs in the Majority of Cardiac Resynchronization Therapy Patients

Introduction The Abbott MultiPoint Pacing (MPP) IDE trial showed safety and efficacy of MPP in cardiac resynchronization therapy patients. Patients programmed to pace from anatomically distant poles (MPP-AS) responded at significantly higher rates than those programmed to other MPP settings. Hypothesis MPP-AS is associated with reduced heart failure-related (HFR) healthcare utilization compared to quadripolar biventricular pacing (QUAD-BiV). Methods All QUAD-BiV and MPP-AS patients from the MPP IDE trial were included. Costs were modeled using a Markov cohort model (1-month cycle length, 10-year time horizon). Rates of HFR hospitalization, emergency room visits, outpatient visits, office visits and death were calculated from the MPP IDE trial. Devices programmed to QUAD-BiV were assumed to have a 7-year battery life, and MPP-AS was assumed to shorten battery life by 9 months. Costs were estimated for each visit type using the Marketscan Database (2012-2016, updated to 2017 using Medical CPI). The simulation was repeated 10,000 times. Results In the MPP IDE trial, 52 patients had MPP-AS programmed and 232 had QUAD-BiV. The MPP-AS group had 2 HFR non-emergency inpatient stays. The QUAD-BiV group had 10 HFR non-emergency inpatient stays, 4 HFR inpatient stays admitted via the ER, 2 HFR outpatient ER visits, 3 HFR outpatient hospitalizations and 3 HFR office visits. Mortality was assumed to be 7% for both groups. The MPP-AS group cost an average of $72,139 (95% CI: $33,070, $117,299) per patient and the QUAD-BiV group cost an average of $92,933 (95% CI: $33,070, $167,211) per patient. MPP-AS resulted in average cost savings of $20,794 (95% CI: -$37,957, $97,124) and in simulation was less expensive than QUAD-BiV 66.6% of the time. MPP-AS had lower expected cost for patients surviving less than 6.25 years or more than 7 years. Conclusions Over a 10-year horizon, MPP-AS was associated with fewer HFR health care events, and in simulation, was less expensive than QUAD-BiV most of the time.