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Published on: February 28, 2012
Cost effectiveness of implantable cardioverter-defibrillators for primary prevention in a Belgian context
Mattias Neyt1, Nancy Thiry, Dirk Ramaekers
1Belgian Health Care Knowledge Centre, Administratief Centrum Kruidtuin, Brussels, Belgium. mattias.neyt@kce.fgov.be
Insights
Primary prevention Implantable Cardioverter-Defibrillator (ICD) therapy is not cost-effective for high-risk patients in Belgium. Lowering device costs and extending service life could improve cost-effectiveness for this sudden cardiac death prevention strategy.
Area of Science:
- Cardiology
- Health Economics
Background:
- Implantable cardioverter-defibrillator (ICD) use for primary prevention of sudden cardiac death is increasing.
- Policy makers question the cost-effectiveness of ICDs in primary prevention scenarios.
- Traditional ICD use targets patients with prior cardiac arrest or symptomatic ventricular tachyarrhythmia.
Purpose of the Study:
- To evaluate the cost-effectiveness of primary prevention ICD therapy compared to conventional therapy.
- Analysis conducted from the perspective of the Belgian health insurance system.
Main Methods:
- A lifetime Markov model with 1-month cycles was utilized.
- Clinical data from the SCD-HeFT study and Belgian cost data (2005 values) were incorporated.
- Probabilistic modeling and sensitivity analyses were performed.
Main Results:
- ICD therapy yielded 1.22 life-years gained (LYG) or 1.03 quality-adjusted life-years (QALYs) gained.
- Lifetime cost-effectiveness ratios were €59,989 per LYG and €71,428 per QALY gained.
- A cost-effectiveness threshold of <€50,000 per QALY gained was met in 15.5% of simulations.
Conclusions:
- Current primary prevention ICD therapy for patients with a SCD-HeFT profile is not cost-effective in Belgium.
- Reducing device prices and extending service life (e.g., to 7 years) could potentially improve cost-effectiveness.
- Patient selection and technological advancements may influence future cost-effectiveness assessments.
Background:
Implantable cardioverter-defibrillator (ICD) therapy was traditionally applied in patients who survived a cardiac arrest or who experienced a symptomatic ventricular tachyarrhythmia. Its use in primary prevention (i.e. in patients who have yet to experience a serious arrhythmic event, but who are considered at high risk for sudden cardiac death) has become more common, and policy makers question whether ICD therapy should be reimbursed in these instances.
Objective:
To assess the cost effectiveness of primary prevention ICD therapy versus conventional therapy from the perspective of the Belgian health insurance system.
Method:
A lifetime 1-month cycle Markov model was constructed and populated with clinical and effectiveness data from the SCD-HeFT study and real-world Belgian cost data expressed in year 2005 values. Probabilistic modelling and sensitivity analyses were performed.
Results:
ICD therapy results in 1.22 life-years gained (LYG) or 1.03 QALYs gained. The lifetime cost-effectiveness and cost-utility ratios were euro 59,989 (95% CI 35 873, 113 518) per LYG and euro 71 428 (95% CI 40 225, 134 623) per QALY gained, respectively. A cost-effectiveness ratio
Conclusions:
ICD therapy may not be judged cost effective for the primary prevention of death in patients with a SCD-HeFT profile in the Belgian context using current technology and patient selection. A combination of price reductions and increased service life of the device may alter this conclusion.
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