A review of the evidence on the effects and costs of implantable cardioverter defibrillator therapy in different patient groups, and the modelling of cost-effectivenessan cost-utility for these groups in a UK context

Abstract

The evidence of short- to medium-term patient benefit from ICDs is strong but cost-effectiveness modelling indicates that the extent of that benefit is probably not sufficient to make the technology cost-effective as used currently in the UK. One reason is the high rates of postimplantation hospitalisation. Better patient targeting and efforts to reduce the need for such hospitalisation may improve cost-effectiveness. Further cost-effectiveness modelling, underpinned by an improved ICD database with reliable long-term follow-up, is required. The absence of a robust measure of the incidence of sudden cardiac death is noted and this may be an area where further organisational changes with improved data collection would help.

Is combined resynchronisation and implantable defibrillator therapy a cost-effective option for left ventricular dysfunction?

“…Furthermore, a recent network meta-analysis incorporating ICD trials reported a very similar overall survival gain with CRT-ICD to that used in the present study [6]. Fourth, and in common with other reported model-based economic analyses of ICD devices [12,15], our model did not explicitly quantify the negative impact of sporadic shocks. Both the AVID and CIDS trials report that patients experiencing ICD shocks have impairment in quality of life compared to those with no shock experience [37,38].…”

“…Although a recent network meta-analysis showed no significant overall survival benefit of CRT-ICD over CRT [6], in the one head-to-head trial to date, CRT-ICD treated patients experienced an additional reduction in the International Journal of Cardiology 137 (2009) 206 -215 www.elsevier.com/locate/ijcard risk of sudden cardiac death compared to those treated by CRT alone [14]. That ICD is the best therapy for the prevention of sudden cardiac death has been established by numerous primary and secondary prevention trials [15]. Nevertheless as highlighted in a recent BMJ editorial, the question remains as to whether the additional clinical and health benefit of CRT-ICD in patients indicated for CRT therapy is sufficient to justify these more costly devices (£5074 for CRT versus £17,266 for CRT-ICD devices) [16][17][18][19].…”

Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia

“…26,27 Such observations argue strongly for efforts to build capacity in the Australian general practice environment to enable chronic disease management programs. Even when the lowest relative effectiveness is modelled with the highest program uptake, these estimates of cost-effectiveness remain below the level commonly applied to novel pharmacotherapies.…”

Custo-efetividade de cardiodesfibriladores implantáveis no Brasil nos setores público e privado

“…In Europe, the English studies published to data have not clearly individualized primary and secondary prevention 34,37 and have not incorporated recent data, such as the SCDHeFT 9 , using only five of the ten studies on primary prevention concluded to date. The most interesting European study available to date was carried out in Belgium, of which model used clinical and effectiveness parameters from the SCDHeFT 38 .…”

“…The estimate of utility for the base-case was 0.88, with no difference between the defibrillator group and the conventional therapy group, in accordance with several previously published studies 13,14,16,31 . At the sensitivity analysis, the values that ranged between the findings in other literature studies [32][33][34][35] were used.…”