Editorial: The economical challenge in the treatment of chronic heart failure: is primary prophylactic implantable cardioverter defibrillator therapy cost-effective in Europe?

Abstract

We read with interest the editorial commenting on our modelling of the cost-effectiveness of primary prophylactic implantable cardioverter defibrillator (ICD) implantation according to the current European guidelines in a European population,1 claiming that our analysis overstated the likely cost-effectiveness of such therapy due to inappropriate assumptions around key determinants of cost and efficacy. Meine et al. mistakenly suggest that the results of our analysis2 were materially different from those from the MADIT II3 and SCD-HeFT4 trials. Our analysis had a life-time model time horizon (as recommended in most recent national and international guidelines for health economic analyses5–7), whereas the two US cost-effectiveness analyses took a (rather arbitrary) 12-year time horizon. If we had taken this time horizon, the incremental cost-effectiveness ratio (ICER) at that point in our analysis would have been €43 752 ($61 253 per QALY at exchange rate of €1: $1.40), similar to the MADIT II ($78 600–$114 000 per life year) and SCD-HeFT analyses ($58 510 per QALY). The more appropriate life-time horizon in our analysis gave an ICER of €31 717 per QALY gained ($44 404). The editorial also suggests that there is a lack of a treatment effect for ICDs in …