title: The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis.
abstract: OBJECTIVE
  It remains unclear whether primary prophylactic implantable cardioverter-defibrillator (ICD) therapy is cost-effective compared with a 'no ICD strategy' in the European health care setting. We performed a cost-effectiveness analysis for a cohort of patients with a left ventricular ejection fraction <40% and ischaemic or non-ischaemic heart disease.
  
  
  RESULTS
  A Markov decision analytic model was used to evaluate long-term survival, quality-adjusted life years (QALYs), and lifetime costs for a cohort of patients with a reduced left ventricular function without previous arrhythmias, managed with a prophylactic ICD. Input data on effectiveness were derived from a meta-analysis of primary prophylactic ICD-only therapy randomized trials, from a prospective cohort study of ICD patients, from a health care utilization survey, and from the literature. Input data on costs were derived from a micro-cost analysis. Data on quality-of-life were derived from the literature. Deterministic and probabilistic sensitivity analysis was performed to assess the uncertainty. Probabilistic sensitivity analysis demonstrated a mean lifetime cost of €50 685 ± €4604 and 6.26 ± 0.64 QALYs for patients in the 'no ICD strategy'. Patients in the 'ICD strategy' accumulated €86 759 ± €3343 and an effectiveness of 7.08 ± 0.71 QALYs yielding an incremental cost-effectiveness ratio of €43 993/QALY gained compared with the 'no ICD strategy'. The probability that ICD therapy is cost-effective was 65% at a willingness-to-pay threshold of €80 000/QALY.
  
  
  CONCLUSIONS
  Our results suggest that primary prophylactic ICD therapy in patients with a left ventricular ejection fraction <40% and ischaemic or non-ischaemic heart disease is cost-effective in the European setting.
authors.affiliation: Department of Cardiology,  Erasmus MC, Rotterdam,  The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Smith
authors.forename: Luc
authors.initials: L
authors.lastname: Jordaens
authors.forename: Dominic A M J
authors.initials: DA
authors.lastname: Theuns
authors.forename: Pascal F
authors.initials: PF
authors.lastname: van Dessel
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Wilde
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000191:economics / Q000401:mortality / Q000628:therapy; D003324:Coronary Artery Disease / Q000191:economics / Q000401:mortality / Q000628:therapy; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008390:Markov Chains; D015337:Multicenter Studies as Topic; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000191:economics* / Q000401:mortality / Q000628:therapy