Cost‐Utility Analysis of Left Bundle Branch Area Versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Multicenter, Prospective, Quasi‐Experimental Study

Abstract

Introduction: Cardiac resynchronization therapy (CRT) is a well‐established treatment for patients with heart failure (HF). Recently, left bundle branch area pacing (LBBAP) has emerged as a more physiological alternative to biventricular pacing (BVP) for CRT. This study aimed to evaluate the cost‐utility of LBBAP CRT compared with BVP CRT. Methods: A cost‐utility, non‐randomized, prospective, multicenter, quasi‐experimental study was performed in four referral centers. Patients eligible for CRT were treated with LBBAP or BVP, depending on the participating center. The primary health outcome was quality‐adjusted life years (QALYs) measured using the EQ‐5D‐5L questionnaire, and the analysis considered the cost of the implant and all procedure‐related events over the 12‐month follow‐up. Clinical outcomes were also evaluated. Results: Sixty‐two consecutive patients were included (42 LBBAP CRT and 20 BVP CRT). Clinical outcomes were similar in both groups. The incremental cost‐utility analysis showed that LBBAP CRT generated an average cost saving of €2391.02 per patient compared with BVP (95% CI −330.28 to 5112.69), while providing an incremental gain of 0.07 QALYs (95% CI −0.03 to 0.16). Conclusions: LBBAP CRT could be an efficient alternative to BVP CRT for cardiac resynchronization with similar clinical and QALY outcomes but potentially significant average cost savings per patient.