CA1 ECONOMIC ANALYSIS OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS INTHE PRIMARY PREVENTION OF SUDDEN CARDIAC DEATH—A CANADIAN PERSPECTIVE

Abstract

CA1 ECONOMIC ANALYSIS OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS INTHE PRIMARY PREVENTION OF SUDDEN CARDIAC DEATH—A CANADIAN PERSPECTIVE Deniz B, Sadri H United BioSource Corporation, Concord, MA, USA, Medtronic of Canada Ltd,Toronto, ON, Canada OBJECTIVE: To conduct a cost-benefit analysis (CB) for the Implantable Cardioverter Defibrillators (ICDs) in the primary prevention of Sudden Cardiac Death (SCD) compared to amiodarone.METHODS: A discrete event simulation model was built to determine the cost-benefit ratio associated with ICDs from a societal perspective in Canada using the “value of life” approach as a measure of “benefit”. The clinical inputs were derived from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) and the Amiodarone Trial Analysis (ATMA) studies. The related costs were derived from the Ontario Health Insuranace Plans’ (OHIP) schedule of benefits and fees, Ontario Drug Benefit formulary (ODB) and published data. The value of life in Canada (CND$5.8Mil.), as determined by Health Canada, was used in the model. One hundred replicaitons of 1000 identical twin pairs over 7 years, aligned with the average life of an ICD, were run. The costs (year 2006) and outcomes ere discounted at 3%. Sensitivity Analysis (SAs) were performed for key input parameters. RESULTS: The absolute all-cause mortality was reduced by eight percent with ICD over seven years compared to amiodarone. The average costs associated with ICD and amiodarone treatments were estimated as CND$32,000 and CND$6400 per patient, respectively. The predicted cost-benefit ratio (CBR) was 0.04. This figure suggests that for every $1 spent for ICD in the primary prevention of SCD the society will gain $25 in “value” by human lives saved. SAs showed that results were robust (CBR: 0.035–0.044). CONCLUSION: IDs reduce the risk of SCD due to arrhythmia compared to amiodarone. The estimated CBR suggests that ICDs are worthwhile investment from a societal perspective in Canada. The initial investment for ICD in primary prevention of SCD in Canada is comparable and in many cases lower when compared to other societal programs for saving lives.