Authors' objectives: HTW aimed to identify and summarise evidence that addressed the following question: what is the clinical and cost effectiveness of percutaneously implanted pulmonary artery pressure sensors plus guideline-directed monitoring of chronic heart failure, compared to guideline-directed monitoring alone?

Authors' results and conclusions: We identified three randomised controlled trials of 1,898 people comparing percutaneously implanted pulmonary artery pressure sensors (PAPS)-directed monitoring of chronic heart failure plus standard care to standard care alone. We pooled outcome data from these trials for some outcomes. We included two observational studies that included outcomes that were not reported in the randomised controlled trials. Two UK-based cost-utility analyses were included in the economic evidence review and were assessed as directly applicable to the research question but with potentially serious limitations. Since these studies were based on effectiveness data from only one of the randomised controlled trials, HTW developed a de novo cost-utility analysis that included effectiveness data from all three randomised controlled trials. The evidence included in this review identifies that there are statistically significant differences in some outcomes to support the effectiveness of PAPS-directed monitoring plus standard care compared to standard care alone. These include a reduction in heart failure hospitalisations and urgent visits, heart failure hospitalisations excluding urgent visits, all-cause hospitalisations, length of hospital stay and levels of natriuretic peptides. Mixed findings for the impact of PAPS-directed monitoring plus standard care on quality-of-life scores was identified. PAPS-directed monitoring plus standard care did not significantly lower cardiovascular deaths, all-cause deaths or the rate of urgent visits for intravenous diuretics for heart failure, compared to standard care alone. The results of the HTW cost-utility analysis, identified an incremental cost-effectiveness ratio (ICER) of £28,523 per quality-adjusted life year (QALY), suggesting that PAPS in addition to standard care is not cost effective compared with standard care alone. However, when several key assumptions in the model were varied simultaneously (including the baseline rate of hospitalisation and the cost of hospitalisations), the ICER was reduced to £14,771 per QALY. If the constant high baseline monthly probability of hospitalisation from a UK observational study was applied (11.8%), together with a lower cost for monitoring, the ICER was £20,418 per QALY.

Authors' recommendations: The evidence supports the routine adoption of percutaneously implanted pulmonary artery pressure sensors (PAPS) to monitor the treatment of people with New York Heart Association class III chronic heart failure and/or a hospitalisation for heart failure within the previous 12 months. The evidence shows that the use of PAPS reduces hospitalisations for heart failure and the length of stay in hospital and may improve quality of life. Expert advice suggests that the baseline rate of hospitalisations in Wales may have been underestimated in the HTW cost-utility analysis and it is therefore plausible that PAPS are cost effective in NHS Wales. The use of PAPS in NHS Wales should be associated with the gathering of real-world evidence of clinical and cost effectiveness.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

Year Published: 2023

URL for published report: https://healthtechnology.wales/reports-guidance/percutaneous-implantation-of-pulmonary-artery-pressure-sensors/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: Floor 3, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk