Cardiac Resynchronization Therapy

Payment mechanism

The payment model for CRT implantation or replacement is DRG in most European countries.

In most countries, the DRG allocation depends on the CRT type with higher DRG tariffs for CRT-D. For example, in the Netherlands, implantation of the CRT-P system is reimbursed via DRG 099899030 “Surgical placement of a pacemaker that improves the pumping function of both the left and right ventricles during hospitalization, cardiology for a cardiac arrhythmia” with 2024 average cost of €16,485. In contrast, implantation of a CRT-D system is allocated to the DRG 979001242 “Implantation of ICD (defibrillator for two heart chambers), including insertion of electrodes for heart disease/lung disease” with a higher 2024 average cost of €23,590.

In most European countries, CRT systems do not attract additional (top-up) reimbursement, which is paid in addition to the DRG tariff. One exception is England, where there are specific add-on categories “ICD with CRT (Cardiac Resynchronisation Therapy) capability” and “Wireless CRT (Cardiac Resynchronisation Therapy) system” in the High Cost Devices List.

Health technology assessment

Due to the high cost and high clinical risks for patients and the existence of different clinical indications, CRT is often the subject of HTA in different European countries. 

For example, in Italy, the National Agency for Regional Health Services (AGENAS) published the rapid HTA report, in which evidence of CRT-D's effectiveness, safety, and cost-effectiveness was compared with ICD and CRT-P in patients with heart failure. The impact of CRT on heart failure depends on appropriate patient selection. No definite conclusion on the cost-effectiveness of CRT-D in comparison to CRT-P could be drawn due to the contradictory study results. However, the post-procedural costs of CRT-D were lower than those for ICD alone, and cost savings could increase in the long term.