Cost-effectiveness of implantable cardioverter-defibrillators for primary prevention in heart failure with reduced ejection fraction: a Markov model using JROAD-DPC cost data in Japan

Introduction: Implantable cardioverter-defibrillators (ICDs) reduce the risk of sudden cardiac death caused by ventricular tachycardia or ventricular fibrillation in patients with ischemic and non-ischemic cardiomyopathy. However, the cost-effectiveness of ICD implantation in Japanese patients with heart failure and reduced left ventricular ejection fraction remains unclear. This study aimed to evaluate the cost-effectiveness of ICD implantation in a Japanese setting. Methods: A Markov model with 1-month cycles was developed to assess the cost-effectiveness of ICD implantation compared with conventional medical therapy. The analysis was conducted from the perspective of a public healthcare payer over a 30-year time horizon. Scenario analyses accounting for waning treatment effects were performed, as along with deterministic and probabilistic sensitivity analyses (PSA). Results: In the base-case analysis, the incremental cost-effectiveness ratio (ICER) was US $29,838 per quality-adjusted life year (QALY). In the scenario analyses, the ICER increased to US $40,205 and $36,199 per QALY when the treatment effect began to wane after 5 and 10 years, respectively. ICD efficacy and battery longevity had the greatest influence on the ICER. PSA showed that the ICER per QALY ranged from US $19,472 at the 2.5th percentile to US $83,365 at the 97.5th percentile. Conclusions: In the Japanese healthcare context, ICD implantation for primary prevention was found to be more cost-effective than the reference value. However, depending on several assumptions, the ICER may exceed the reference value. Sensitivity analyses highlighted the significant impact of the hazard ratio and battery longevity on cost-effectiveness. Further research is needed to identify subpopulations with significantly different cost-effectiveness outcomes.