1. Implantable cardioverter defibrillator therapy is cost effective for primary prevention patients in Taiwan: An analysis from the Improve SCA trial
- Author
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Yu-Cheng Hsieh, Kael Wherry, Lucas Higuera, Kuo-Hung Lin, Dave Phay, Reece Holbrook, and Yen-Bin Liu
- Subjects
Male ,Medical Implants ,Economics ,Epidemiology ,medicine.medical_treatment ,Social Sciences ,Sudden Cardiac Death ,Sudden cardiac death ,Geographical Locations ,Risk Factors ,Medicine and Health Sciences ,Medicine ,education.field_of_study ,Multidisciplinary ,Cost-effectiveness analysis ,Implantable cardioverter-defibrillator ,Markov Chains ,Defibrillators, Implantable ,Primary Prevention ,Cohort ,Engineering and Technology ,Female ,Quality-Adjusted Life Years ,medicine.symptom ,Incremental cost-effectiveness ratio ,Research Article ,Biotechnology ,medicine.medical_specialty ,Asia ,Patients ,Science ,Population ,Cost-Effectiveness Analysis ,Cardiology ,Taiwan ,Bioengineering ,Humans ,education ,Heart Failure ,Inpatients ,business.industry ,Biology and Life Sciences ,Sudden cardiac arrest ,medicine.disease ,Economic Analysis ,Quality-adjusted life year ,Health Care ,Death, Sudden, Cardiac ,Medical Risk Factors ,Emergency medicine ,People and Places ,Medical Devices and Equipment ,business - Abstract
Objective Implantable cardiac defibrillators (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) are 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 certain risk factors. We evaluated the cost-effectiveness of ICD therapy compared to no ICD among the PP population and the subset of 1.5PP patients in Taiwan. Methods A Markov model was run over a lifetime time horizon from the Taiwan payer perspective. Mortality and utility estimates were obtained from the literature (PP) and the IMPROVE SCA trial (1.5PP). Cost inputs were obtained from the Taiwan National Health Insurance Administration (NHIA), Ministry of Health and Welfare. We used a willingness-to-pay (WTP) threshold of NT$2,100,000, as established through standard WTP research methods and in alignment with World Health Organization recommendations. Results The total discounted costs for ICD therapy and no ICD therapy were NT$1,664,259 and NT$646,396 respectively for PP, while they were NT$2,410,603 and NT$905,881 respectively for 1.5PP. Total discounted QALYs for ICD therapy and no ICD therapy were 6.48 and 4.98 respectively for PP, while they were 10.78 and 7.71 respectively for 1.5PP. The incremental cost effectiveness ratio was NT$708,711 for PP and NT$441,153 for 1.5PP, therefore ICD therapy should be considered cost effective for PP and highly cost effective for 1.5PP. Conclusions ICD therapy compared to no ICD therapy is cost-effective in the whole PP population and highly cost-effective in the subset 1.5PP population in Taiwan.
- Published
- 2020