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Published on: February 28, 2012
Cost-effectiveness of primary implanted cardioverter defibrillator for sudden death prevention in congestive heart
1Department of Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, CA 90089, USA.
Insights
Primary prophylactic implantable cardioverter defibrillators (ICDs) are not cost-effective for preventing sudden death in congestive heart failure (CHF) patients. Standard drug therapy offers better value, as ICDs exceed typical cost-effectiveness thresholds for CHF sudden death prevention.
Area of Science:
- Health Economics
- Cardiology
- Medical Technology Assessment
Background:
- Implantable cardioverter defibrillators (ICDs) are effective but costly interventions for preventing sudden cardiac death.
- The cost-effectiveness of primary prophylactic ICDs in congestive heart failure (CHF) patients remains underexplored.
Purpose of the Study:
- To compare the cost-effectiveness of primary prophylactic ICDs versus standard drug therapy for preventing sudden death in CHF patients.
- To evaluate the economic value of ICDs in this specific patient population.
Main Methods:
- A lifetime decision model was employed to calculate the incremental cost per Quality-Adjusted Life Year (QALY).
- Data on costs, utilities, and probabilities were sourced from literature, expert opinion, and official fee schedules.
- The target population comprised U.S. CHF patients classified as NYHA functional Class II and III.
Main Results:
- The discounted lifetime cost for ICDs was $122,947, yielding 2.9031 QALYs, compared to $25,223 and 1.9045 QALYs for standard therapy.
- The incremental cost-effectiveness ratio (ICER) for prophylactic ICDs was $97,861 per QALY gained.
- Sensitivity analyses indicated that ICDs are unlikely to be cost-effective at thresholds of $50,000-$80,000 per QALY.
Conclusions:
- Primary prophylactic ICD implantation is unlikely to be a cost-effective strategy for preventing sudden death in CHF patients compared to standard drug therapy.
- The cost-effectiveness is highly sensitive to patient utility post-implantation and the incidence of sudden death in CHF patients.
Background:
Implanted cardioverter defibrillator (ICD) is expensive but highly effective in preventing sudden death. The value of primary prophylactic ICD in preventing sudden death for congestive heart failure patients (CHF) has not been established.
Objective:
To compare the cost-effectiveness of primary prophylactic ICD vs. standard drug therapy for preventing CHF sudden death.
Design:
Incremental Cost per Quality-Adjusted Life Year (QALY) using a lifetime decision model.
Data Sources:
Estimates of cost, utility and probabilities from literature, clinical experts, CMS fee schedule payments, and the Bureau of Labor Statistics.
Target Population:
U.S. CHF patients with NYHA functional Class II and III.
Time Horizon:
Lifetime; future values discounted at 3%.
Perspective:
Societal.
Results Of Base-Case Analysis:
In 2002 prices the discounted lifetime cost is 122,947 dollars with primary prophylactic ICD and 25,223 dollars without ICD; the QALYs gained were 2.9031 and 1.9045 respectively. The incremental cost-effectiveness ratio was 97,861 dollars per QALY saved with prophylactic ICD.
Results Of Sensitivity Analysis:
ICD is not cost-effective under plausible scenarios using 50,000-80,000 dollars per QALY as the cost effectiveness threshold. The cost-effectiveness ratio is quite sensitive to patient utility after ICD implantation, and the proportion of CHF patients experiencing sudden death.
Conclusions:
Using a standard cost-effectiveness threshold and plausible parameter ranges, it is unlikely that ICD is cost-effectiveness in preventing CHF sudden death relative to standard drug therapy.
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