Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population

Martin R. Cowie; Deborah Marshall; Michael Drummond; Nicole Ferko; Michael Maschio; Matthias Ekman; Luc de Roy; Hein Heidbuchel; Yves Verboven; Frieder Braunschweig; Cecilia Linde; Giuseppe Boriani

doi:10.1093/europace/eup068

Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population

Martin R. Cowie, Deborah Marshall, Michael Drummond, Nicole Ferko, Michael Maschio, Matthias Ekman, Luc de Roy, Hein Heidbuchel, Yves Verboven, Frieder Braunschweig, Cecilia Linde, Giuseppe Boriani

Centre for Health Economics

Research output: Contribution to journal › Article › peer-review

Abstract

Current European guidelines recommend prophylactic implantation of cardioverter defibrillators (ICDs) in patients with a reduced left ventricular ejection fraction (LVEF) who are not in NYHA class IV and have reasonable life expectancy. Cost and benefit implications of this recommendation have not been reported from a European perspective.

Markov modelling estimated lifetime costs and effects [life years (LY) and quality-adjusted LY (QALY) gained] of prophylactic ICD implantation vs. conventional treatment, among patients with a reduced LVEF. Efficacy was estimated from a meta-analysis of mortality rates in the six primary prevention trials with inclusion criteria matching ACC/AHA/ESC Class I or IIa recommendations. Direct medical costs were estimated using Belgian national references. Costs and effects were discounted at 3 and 1.5% per annum, respectively. Probabilistic sensitivity and scenario analyses estimated the uncertainty around the incremental cost-effectiveness ratio. An ICD implantation increased the lifetime direct costs by Euro46 413. Estimated mean LY/QALY gained were 1.88/1.57, respectively. Probabilistic analysis estimated mean lifetime cost per QALY gained as Euro31 717 (95% CI: Euro19 760-Euro61 316). Cost-effectiveness was influenced most by ICD efficacy, time to replacement, utility, and patient age at implantation.

In a European healthcare setting, prophylactic ICD implantation may be cost-effective if current guidelines for patients with a reduced LVEF are followed.

Original language	English
Pages (from-to)	716-726
Number of pages	11
Journal	Europace
Volume	11
Issue number	6
DOIs	https://doi.org/10.1093/europace/eup068
Publication status	Published - Jun 2009

Keywords

Cost-effectiveness analysis
Decision analytic model
Europe
Prophylactic implantable cardioverter defibrillator
Sudden death
Left ventricular ejection fraction
SUDDEN CARDIAC DEATH
NONISCHEMIC DILATED CARDIOMYOPATHY
EFFECTIVENESS ACCEPTABILITY CURVES
PULSE-GENERATOR
HEART-FAILURE
TRIAL
PREVENTION
AMIODARONE
RISK
PACEMAKER

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10.1093/europace/eup068

http://europace.oxfordjournals.org/content/11/6/716

Cite this

Cowie, M. R., Marshall, D., Drummond, M., Ferko, N., Maschio, M., Ekman, M., de Roy, L., Heidbuchel, H., Verboven, Y., Braunschweig, F., Linde, C., & Boriani, G. (2009). Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population. Europace, 11(6), 716-726. https://doi.org/10.1093/europace/eup068

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title = "Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population",

abstract = "Current European guidelines recommend prophylactic implantation of cardioverter defibrillators (ICDs) in patients with a reduced left ventricular ejection fraction (LVEF) who are not in NYHA class IV and have reasonable life expectancy. Cost and benefit implications of this recommendation have not been reported from a European perspective.Markov modelling estimated lifetime costs and effects [life years (LY) and quality-adjusted LY (QALY) gained] of prophylactic ICD implantation vs. conventional treatment, among patients with a reduced LVEF. Efficacy was estimated from a meta-analysis of mortality rates in the six primary prevention trials with inclusion criteria matching ACC/AHA/ESC Class I or IIa recommendations. Direct medical costs were estimated using Belgian national references. Costs and effects were discounted at 3 and 1.5% per annum, respectively. Probabilistic sensitivity and scenario analyses estimated the uncertainty around the incremental cost-effectiveness ratio. An ICD implantation increased the lifetime direct costs by Euro46 413. Estimated mean LY/QALY gained were 1.88/1.57, respectively. Probabilistic analysis estimated mean lifetime cost per QALY gained as Euro31 717 (95% CI: Euro19 760-Euro61 316). Cost-effectiveness was influenced most by ICD efficacy, time to replacement, utility, and patient age at implantation.In a European healthcare setting, prophylactic ICD implantation may be cost-effective if current guidelines for patients with a reduced LVEF are followed.",

keywords = "Cost-effectiveness analysis, Decision analytic model, Europe, Prophylactic implantable cardioverter defibrillator, Sudden death, Left ventricular ejection fraction, SUDDEN CARDIAC DEATH, NONISCHEMIC DILATED CARDIOMYOPATHY, EFFECTIVENESS ACCEPTABILITY CURVES, PULSE-GENERATOR, HEART-FAILURE, TRIAL, PREVENTION, AMIODARONE, RISK, PACEMAKER",

author = "Cowie, {Martin R.} and Deborah Marshall and Michael Drummond and Nicole Ferko and Michael Maschio and Matthias Ekman and {de Roy}, Luc and Hein Heidbuchel and Yves Verboven and Frieder Braunschweig and Cecilia Linde and Giuseppe Boriani",

year = "2009",

month = jun,

doi = "10.1093/europace/eup068",

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Cowie, MR, Marshall, D, Drummond, M, Ferko, N, Maschio, M, Ekman, M, de Roy, L, Heidbuchel, H, Verboven, Y, Braunschweig, F, Linde, C & Boriani, G 2009, 'Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population', Europace, vol. 11, no. 6, pp. 716-726. https://doi.org/10.1093/europace/eup068

Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population. / Cowie, Martin R.; Marshall, Deborah; Drummond, Michael et al.
In: Europace, Vol. 11, No. 6, 06.2009, p. 716-726.

Research output: Contribution to journal › Article › peer-review

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T1 - Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function

T2 - results of Markov modelling in a European population

AU - Cowie, Martin R.

AU - Marshall, Deborah

AU - Drummond, Michael

AU - Ferko, Nicole

AU - Maschio, Michael

AU - Ekman, Matthias

AU - de Roy, Luc

AU - Heidbuchel, Hein

AU - Verboven, Yves

AU - Braunschweig, Frieder

AU - Linde, Cecilia

AU - Boriani, Giuseppe

PY - 2009/6

Y1 - 2009/6

N2 - Current European guidelines recommend prophylactic implantation of cardioverter defibrillators (ICDs) in patients with a reduced left ventricular ejection fraction (LVEF) who are not in NYHA class IV and have reasonable life expectancy. Cost and benefit implications of this recommendation have not been reported from a European perspective.Markov modelling estimated lifetime costs and effects [life years (LY) and quality-adjusted LY (QALY) gained] of prophylactic ICD implantation vs. conventional treatment, among patients with a reduced LVEF. Efficacy was estimated from a meta-analysis of mortality rates in the six primary prevention trials with inclusion criteria matching ACC/AHA/ESC Class I or IIa recommendations. Direct medical costs were estimated using Belgian national references. Costs and effects were discounted at 3 and 1.5% per annum, respectively. Probabilistic sensitivity and scenario analyses estimated the uncertainty around the incremental cost-effectiveness ratio. An ICD implantation increased the lifetime direct costs by Euro46 413. Estimated mean LY/QALY gained were 1.88/1.57, respectively. Probabilistic analysis estimated mean lifetime cost per QALY gained as Euro31 717 (95% CI: Euro19 760-Euro61 316). Cost-effectiveness was influenced most by ICD efficacy, time to replacement, utility, and patient age at implantation.In a European healthcare setting, prophylactic ICD implantation may be cost-effective if current guidelines for patients with a reduced LVEF are followed.

AB - Current European guidelines recommend prophylactic implantation of cardioverter defibrillators (ICDs) in patients with a reduced left ventricular ejection fraction (LVEF) who are not in NYHA class IV and have reasonable life expectancy. Cost and benefit implications of this recommendation have not been reported from a European perspective.Markov modelling estimated lifetime costs and effects [life years (LY) and quality-adjusted LY (QALY) gained] of prophylactic ICD implantation vs. conventional treatment, among patients with a reduced LVEF. Efficacy was estimated from a meta-analysis of mortality rates in the six primary prevention trials with inclusion criteria matching ACC/AHA/ESC Class I or IIa recommendations. Direct medical costs were estimated using Belgian national references. Costs and effects were discounted at 3 and 1.5% per annum, respectively. Probabilistic sensitivity and scenario analyses estimated the uncertainty around the incremental cost-effectiveness ratio. An ICD implantation increased the lifetime direct costs by Euro46 413. Estimated mean LY/QALY gained were 1.88/1.57, respectively. Probabilistic analysis estimated mean lifetime cost per QALY gained as Euro31 717 (95% CI: Euro19 760-Euro61 316). Cost-effectiveness was influenced most by ICD efficacy, time to replacement, utility, and patient age at implantation.In a European healthcare setting, prophylactic ICD implantation may be cost-effective if current guidelines for patients with a reduced LVEF are followed.

KW - Cost-effectiveness analysis

KW - Decision analytic model

KW - Europe

KW - Prophylactic implantable cardioverter defibrillator

KW - Sudden death

KW - Left ventricular ejection fraction

KW - SUDDEN CARDIAC DEATH

KW - NONISCHEMIC DILATED CARDIOMYOPATHY

KW - EFFECTIVENESS ACCEPTABILITY CURVES

KW - PULSE-GENERATOR

KW - HEART-FAILURE

KW - TRIAL

KW - PREVENTION

KW - AMIODARONE

KW - RISK

KW - PACEMAKER

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DO - 10.1093/europace/eup068

M3 - Article

SN - 1099-5129

VL - 11

SP - 716

EP - 726

JO - Europace

JF - Europace

IS - 6

ER -

Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population

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Keywords

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