Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population.
OBJECTIVE
Current European guidelines recommend prophylactic implantation of cardioverter defibrillators (ICDs) in patients with a reduced left ventricular ejection fraction (LVEF) who are not in NYHA class IV and have reasonable life expectancy. Cost and benefit implications of this recommendation have not been reported from a European perspective.


RESULTS
Markov modelling estimated lifetime costs and effects [life years (LY) and quality-adjusted LY (QALY) gained] of prophylactic ICD implantation vs. conventional treatment, among patients with a reduced LVEF. Efficacy was estimated from a meta-analysis of mortality rates in the six primary prevention trials with inclusion criteria matching ACC/AHA/ESC Class I or IIa recommendations. Direct medical costs were estimated using Belgian national references. Costs and effects were discounted at 3 and 1.5% per annum, respectively. Probabilistic sensitivity and scenario analyses estimated the uncertainty around the incremental cost-effectiveness ratio. An ICD implantation increased the lifetime direct costs by euro 46,413. Estimated mean LY/QALY gained were 1.88/1.57, respectively. Probabilistic analysis estimated mean lifetime cost per QALY gained as euro 31,717 (95% CI: euro 19,760-euro 61,316). Cost-effectiveness was influenced most by ICD efficacy, time to replacement, utility, and patient age at implantation.


CONCLUSIONS
In a European healthcare setting, prophylactic ICD implantation may be cost-effective if current guidelines for patients with a reduced LVEF are followed.
Clinical Cardiology, National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK. m.cowie@imperial.ac.uk
Martin R
MR
Cowie
Deborah
D
Marshall
Michael
M
Drummond
Nicole
N
Ferko
Michael
M
Maschio
Matthias
M
Ekman
Luc
L
de Roy
Hein
H
Heidbuchel
Yves
Y
Verboven
Frieder
F
Braunschweig
Cecilia
C
Linde
Giuseppe
G
Boriani
D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008955:Models, Cardiovascular; D018803:Models, Economic; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*