The Cost-Effectiveness of Primary Prophylactic Implantable Defibrillator Therapy in Patients With Ischemic or Non-Ischemic Heart Disease: An European Analysis

Study Questions:

How cost-effective are implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden cardiac death (SCD)?

Methods:

A Markov decision analytic model was developed based on data from primary prevention ICD trials and registries. Patients eligible for an ICD had an ejection fraction <40% and ischemic or nonischemic cardiomyopathy. Cost estimates were reported in 2010 Euros. The incremental cost-effectiveness ratio (ICER) was defined as the difference in costs divided by the difference in effectiveness (i.e., quality-adjusted life-year [QALY] gained) for an ICD strategy compared to a no-ICD strategy.

Results:

In the analysis, ICD therapy incurred a lifetime cost of €86,759 and was associated with an effectiveness of 7.08 QALYs. A no-ICD strategy incurred a lifetime cost of €50,685 and was associated with an effectiveness of 6.26 QALYs. The ICER of ICD therapy was €43,993/QALY gained. Using a benchmark cost-effectiveness of €80,000/QALY, a probabilistic sensitivity analysis indicated that ICD therapy was cost-effective in 65% of simulations.

Conclusions:

The authors concluded that ICD therapy for primary prevention of SCD is likely to be cost-effective in Europe.

Perspective:

When expressed in terms of 2010 US dollars, the results indicate that the ICER of ICD therapy in Europe is $58,269/QALY gained. In comparison, the ICER of primary prevention ICDs based on the SCD-HeFT and MADIT-II trials had a wide range of approximately $40,100-$461,000 per QALY gained. However, when a lifetime horizon was applied in modeling studies, the ICERs had a much narrower range of approximately $35,000-$70,000/QALY gained. These results suggest that the cost-effectiveness of ICD therapy is similar in Europe and the United States.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Cardiomyopathies, Europe, Death, Sudden, Cardiac, Defibrillators, Implantable, Primary Prevention


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