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ference between treatment and control on all ABP parameters,
both at the 12 week primary outcome and at any other time point.
For example, the change in 24HR SBP/DBP at 12 weeks between
treatment and control was only 0.0/0.4 mmHg (⫹/⫺7.2/4.7),
p⫽0.96 for SBP and p⫽0.63 for DBP (the blood pressure values
have been corrected and respective p-values included). This study
had 81% power to detect a 24 hour systolic BP difference of 6.0
mmHg with 37 participants per group.
CONCLUSIONS: MBSR was found to be ineffective in lowering BP
by 6 mmHg or more among stage-1 unmedicated hypertensives.
Revisiting the literature, most positive studies using meditation
techniques for blood pressure lowering included many subjects
taking anti-hypertensive therapy. In 2 negative studies all subjects
were drug naïve. Therefore, it seems probable that studies finding
a reduction in BP may have been confounded by improved med-
ication adherence. While it is disappointing that the HARMONY
study did not find a blood pressure lowering effect on drug naïve
hypertensives, mind-body interventions may improve BP control
among the medicated. Our next steps include using MBSR as
adjunctive therapy for better BP control, as well assessing its use in
improving drug adherence/persistence.
905
COST EFFECTIVENESS OF CARDIAC RESYNCHRONIZATION
THERAPY (CRT) FOR MILD TO MODERATE HEART FAILURE
GA Wells, D Coyle, K Coyle, M Talajic, A Tang
Ottawa, Ontario
BACKGROUND: The objective of this study was to assess the cost
effectiveness of ICD-CRT versus ICD alone in patients with left
ventricular dysfunction and a wide QRS complex. In a recent
randomized controlled trial (RAFT), the addition of CRT to an
implantable cardiodefibrillator (ICD) in this group of patients was
shown to reduce rates of death and hospitalization for heart failure.
METHODS: Analysis assessed the health care related costs and
quality adjusted life years for both the ICD-CRT and ICD
groups over a 40 year time horizon. The time horizon was
facilitated by a Markov model developed by combining data for
the 1798 patients enrolled within the RAFT with long term
data on the longevity of the devices. Costs and benefits in terms
of quality adjusted life years (QALYs) were discounted at 3%
per annum. Health care resources included the initial device
plus device replacements, cardiovascular and non cardiovascu-
lar related hospitalizations in addition to drug costs, physician
visits and long term care. Resource use was weighted by appro-
priate unit costs from the USA. Uncertainty concerning cost
effectiveness was assessed through Monte Carlo simulation and
deterministic sensitivity analysis.
RESULTS: Models for Canadian resource utilization and costing
have been developed and are currently being conducted. For
the US models, the use of ICD-CRT was estimated to lead to
an average increase in costs of $35,308 and an average increase
in QALYs of 1.07. The incremental cost per QALY gained was
$33,025. ICD-CRT was not cost effective for patients with
atrial fibrillation and those with preexisting ventricular pacing.
CONCLUSIONS: ICD-CRT is cost effective for the population
studied within the RAFT clinical trial.
Abstracts S419
