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.