Systematic review finds CRT plus optimized medical therapy is highly cost-effective for symptomatic heart failure patients

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.