Systematic review finds CRT plus optimized medical therapy is highly cost-effective for symptomatic heart failure patientsHeart Failure Therapy Costs Vary by Device Type

Frontiers in Medicine Published May 22, 2026 DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider prioritizing CRT-P as a high-value therapy while reserving CRT-D for selected high-risk patients.

This systematic review examined eighteen studies involving patients with heart failure with reduced ejection fraction who remain symptomatic despite optimized medical therapy. The primary focus was on cost-effectiveness, specifically looking at incremental cost-effectiveness ratios and quality-adjusted life years. The review compared the combination of cardiac resynchronization therapy and optimized medical therapy against optimized medical therapy alone, as well as comparing CRT-P versus CRT-D devices.

The findings suggest that adding cardiac resynchronization therapy to optimized medical therapy is highly cost-effective. In contrast, the cost-effectiveness of choosing between CRT-P and CRT-D devices is variable and often exceeds accepted willingness-to-pay thresholds in many countries. The authors observed that these economic outcomes support specific strategies for device selection within advanced heart failure care.

The study authors note that safety data and adverse events were not reported in the included studies. Consequently, the certainty of the findings regarding clinical safety remains unclear. The practice relevance supports prioritizing CRT-P as a high-value therapy while reserving CRT-D for selected high-risk patients. Clinicians should interpret these economic results cautiously given the lack of reported safety data and the variable nature of device comparisons.

A systematic review examined eighteen studies involving patients with heart failure who remained symptomatic despite standard medical therapy. The researchers compared adding cardiac resynchronization therapy to standard care versus standard care alone. They also looked at the difference between using a pacemaker with a defibrillator versus one without a defibrillator. The analysis covered multiple healthcare settings but did not report specific safety data or adverse events. The main reason to be careful is that cost-effectiveness results varied significantly depending on the specific device chosen. Readers should understand that while adding the therapy is generally cost-effective, choosing a defibrillator-capable device may not always be the most economical option. The review supports prioritizing the simpler device as a high-value therapy within advanced heart failure care. This approach suggests reserving the more complex device for selected high-risk patients. The findings help guide decisions on resource use without claiming to change clinical practice for everyone.

What this means for you:

Adding cardiac resynchronization therapy is cost-effective, but device choice affects value for heart failure patients.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Background and aimHeart failure (HF) remains a global public health challenge, with high morbidity, mortality, and healthcare costs despite advances in pharmacological and interventional therapies. Cardiac resynchronization therapy (CRT) reduces symptoms, hospitalizations, and mortality, but is associated with increased healthcare costs. This review aims to evaluate the existing evidence on the cost-effectiveness of CRT compared with standard optimal medical therapy.MethodsA systematic search of Web of Science, PubMed, and Scopus was conducted from January 2004 up to July 2025 to identify studies reporting economic outcomes such as quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) for CRT treatment in addition to optimal medical therapy (OMT) compared to OMT only. The study was registered in PROSPERO. We included studies comparing CRT plus OMT with OMT alone, as well as CRT-P vs. CRT-D. Costs were converted to 2024 euros (€) and assessed against country-specific willingness-to-pay thresholds.ResultsEighteen studies met the inclusion criteria and were included in the final review CRT + OMT proved to be highly cost-effective across multiple healthcare settings: ICERs ranged from €3,048-€71,447/QALY gained. CRT-D compared with CRT-P showed more cost variability, with ICERs varying between €24,909-€105,572/QALY gained, often exceeding accepted country-specific willingness-to-pay thresholds.ConclusionsThis review confirms that CRT, particularly CRT-P, is a cost-effective treatment for patients with HFrEF who remain symptomatic despite OMT. CRT-D had variable cost-effectiveness, thus should be reserved for selected high-risk patients. These findings support prioritizing CRT-P as a high-value therapy within advanced heart failure care.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251171292, PROSPERO CRD420251171292.

Systematic review finds CRT plus optimized medical therapy is highly cost-effective for symptomatic heart failure patientsHeart Failure Therapy Costs Vary by Device Type

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