98/Cost-effective analysis of a dedicated and specialised cardiac resynchronisation therapy pre-assessment clinic

Background: Cardiac resynchronisation therapy (CRT) is an important intervention in patients with dyssynchronous severe left ventricular systolic impairment. Appropriate patient selection is important, given
30–40% of patients fail to respond to CRT. Patient evaluation before CRT remains heterogenous across centres and it’s suspected a proportion of patients with unfavourable characteristics such as narrow QRS duration
proceed to implantation. We developed a unique CRT pre-assessment clinic (CRT PAC) to act as a final review for patients already considered for CRT to determine whether they should proceed to implantation.
Purpose: We hypothesised this clinic would find some patients unsuitable for CRT due to updated investigations and closer patient scrutiny. The purpose of this analysis was to determine whether the CRT PAC led to
savings for the National Health Service (NHS).
Methods: A decision tree model was made to evaluate two clinical pathways; (1) standard of care where all patients initially seen in an outpatient cardiology clinic proceeded directly to CRT and (2) management
of patients in CRT PAC. Patients were considered CRT responders if (A) they had improvement in their clinical composite score and (B) an improvement in in left ventricular end-systolic volume (LVESV) of ≥15%.
Results: Two-hundred and fifty-two patients were reviewed in the CRT PAC; 192 were eligible to proceed directly for CRT and 48 patients did not meet consensus guidelines for CRT so were not implanted. Overall, 81.6%
of patients had improvement in their clinical composite score and 56.5% had improvement in LVESV ≥15%. Using the decision tree model, the total savings for the NHS was £966,000, representing a saving of 21.8%. Additionally, if this model was applied throughout the NHS the potential savings could be as much as £35 million.
Conclusions: CRT PAC appropriately select patients and results in substantial savings for the NHS. Adopting this clinic across the NHS has the potential to save £35 million, especially important in an already burdened healthcare system.