Cost-effectiveness of primary prevention implantable cardioverter defibrillator treatment: data from a large clinical registry.

BackgroundAlthough randomized trials have shown the beneficial effect on survival of an implantable cardioverter defibrillator (ICD) as primary prevention therapy in selected patients, data concerning the cost-effectiveness in routine clinical practice remain scarce. Accordingly, the purpose of this study was to assess the cost-effectiveness of primary prevention ICD implantation in the real world. MethodsPatients receiving primary prevention single-chamber or dual-chamber ICD implantation at the Leiden University Medical Center were included in the study. Using a Markov model, lifetime cost, life years (LYs), and gained quality-adjusted life years (QALYs) were estimated for device recipients and control patients. Data on mortality, complication rates, and device longevity were retrieved from our center and entered into the Markov model. To account for model assumptions, one-way deterministic and probabilistic sensitivity analyses were performed. Importantly, calculations for the estimated incremental cost-effectiveness rate (ICER) per QALY gained are based on several numbers of assumptions, and accordingly findings may have over- or underestimated the cost-effectiveness of ICD therapy. ResultsPrimary prevention ICD implantation adds an estimated mean of 2.07 LYs and 1.73 QALYs. Increased lifetime cost for single-chamber and dual-chamber ICD recipients were estimated at Euro60,788 and Euro64,216, respectively. This resulted for single-chamber ICD recipients, in an estimated ICER of Euro35,154 per QALY gained. In dual-chamber ICD recipients, an estimated ICER of Euro37,111 per QALY gained was calculated. According to the probabilistic sensitivity analysis, estimated cost per QALY gained are Euro35,837 (95% confidence interval [CI]: Euro28,368-Euro44,460) for single-chamber and Euro37,756 (95% CI: Euro29,055-Euro46,050) for dual-chamber ICDs. ConclusionsOn the basis of data and detailed costs, derived from routine clinical practice, ICD therapy in selected patients with a reduced left ventricular ejection fraction appears to be cost-effective.