CV4 Cost-Effectiveness of Implantable Cardioverter-Defibrillator in Patients With Risk Factors for Sudden Death in Argentina

Abstract

To conduct a cost-utility evaluation of dabigatran etexilate compared with enoxaparin for the prevention of venous thromboembolism (VTE) after total knee replacement (TKR) and total hip replacement (THR) in Colombia. METHODS: An acute phase model, using decision analysis, and a long-term simulation Markov model were developed to compare the clinical outcomes, utilities, and direct medical costs of dabigatran 220 mg once daily and subcutaneous enoxaparin 40 mg once daily for VTE prophylaxis after TKR or THR. Time frame for the acute inpatient-phase was 14 days for TKR and 30 days for THR; adjustments for adverse events and average length of hospital stay were performed. The long-term simulation was performed using 6-months cycle transitions to eight health states for both TKR and THR. Transition probabilities for VTE and bleeding events were derived from Phase III studies comparing the two treatments. The probabilities of long-term events were estimated using data from published longitudinal studies. The payer perspective for a lifetime horizon was used. Sensitivity analyses were performed to assess the model robustness. The annual discount rate was set at 3.

Economic Issues in Heart Failure in the United States

“…If one assumes a benefit of ICD therapy to prolong good quality life, the longer time horizon in primary prevention analyses (3.5 years to lifetime) tends to make these analyses more favorable. The Multicenter Automatic Defibrillator Implantation Trial (MADIT) in ischemic heart failure showed clear efficacy of ICD implantation, leading to highly cost-effective ICERs based on these criteria from $19,148 -$54,802/QALY [62][63][64][65] The case in non-ischemic cardiomyopathy depends on the level of risk reduction assumed, and here variability in randomized trial data makes modeling challenging.…”

“…Using data from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), models provide an ICER in 2011 US dollars between $79,579 -$155,400/QALY. [62][63][64] Secondary Prevention Defibrillators Initial trials of ICD implantation in patients who had had an episode of ventricular arrhythmia or sudden cardiac death showed a profound benefit of the devices to reduce mortality when compared to active anti-arrhythmic therapy. [60] Implantation of an ICD for secondary prevention is a class I, level of evidence B recommendation in survivors of sudden death due to ventricular fibrillation (VF) or hemodynamically unstable sustained ventricular tachycardia (VT) [61] Nevertheless, economic models of ICD therapy show a broad range of results, even in the relatively clear-cut case of secondary prevention.…”