Cost-Effectiveness Analysis of Implantable Cardioverter Defibrillator Therapy for Primary Prevention Patients with Additional Risk Factors in Brazil

Kael Wherry,Reece Holbrook,Lucas Higuera,Diego A Rodriguez,Francis Fujii

doi:10.36660/ijcs.20200016

Abstract

Abstract Background: Implantable cardiac defibrillators (ICDs) therapy for primary prevention (PP) of sudden cardiac arrest (SCA) is well-established but underutilized globally. The Improve SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP), based on PP patients with the presence of documented risk factors: non-sustained ventricular tachycardia, frequent premature ventricular contractions, left ventricular ejection fraction < 25%, and pre-syncope or syncope. Objective: This study evaluated the cost-effectiveness of ICD therapy compared to no ICD among 1.5PP patients [...]

Highlights

Evidence for the use of implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac arrest (SCA) in patients with moderately symptomatic heart failure and reduced systolic function has been well-established through multiple randomized clinical trials 1,2 and confirmed in realworld observational evidence.[3]
Implantable Cardioverter-Defibrillator (ICD) therapy for 1.5 prevention resulted in a benefit of 11.79 and 13.41 life-years saved, while no ICD therapy resulted in a benefit of 8.54 and 9.46 life-years saved, respectively
Our results indicate that ICD therapy is highly cost effective for 1.5 primary prevention (PP) patients in the Brazilian healthcare system, which at an incremental cost effectiveness ratio (ICER) of R$21,156 per quality-adjusted life year (QALY) is less than one-third the WTP value of R$105,723

Summary

Introduction

Evidence for the use of implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac arrest (SCA) in patients with moderately symptomatic heart failure and reduced systolic function has been well-established through multiple randomized clinical trials 1,2 and confirmed in realworld observational evidence.[3]. The Improve SCA study has identified a high-risk subset of primary prevention patients called 1.5 primary prevention (PP) based on the presence of at least one of the following documented risk factors: non-sustained ventricular tachycardia (NSVT), frequent premature. Implantable cardiac defibrillators (ICDs) therapy for primary prevention (PP) of sudden cardiac arrest (SCA) is well-established but underutilized globally. The Improve SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP), based on PP patients with the presence of documented risk factors: non-sustained ventricular tachycardia, frequent premature ventricular contractions, left ventricular ejection fraction < 25%, and pre-syncope or syncope. Objective: This study evaluated the cost-effectiveness of ICD therapy compared to no ICD among 1.5PP patients in the Brazilian public healthcare system.

Objectives

Methods

Results

Conclusion