Key result
ICD therapy for primary prevention of sudden cardiac arrest is cost-effective in Mexico and Uruguay and potentially cost-effective in Colombia, with ICERs between 1-3 times GDP per capita.
Why the study?
ICD therapy for primary prevention of sudden cardiac arrest is underutilized globally despite established mortality benefits.
Is ICD therapy cost-effective compared to no ICD therapy for primary prevention of sudden cardiac arrest in patients with 1.5PP characteristics in Latin America?
Is ICD therapy cost-effective compared to no ICD therapy for primary prevention of sudden cardiac arrest in patients with 1.5PP characteristics in Latin America?
ICD therapy is cost-effective in Mexico and Uruguay and potentially cost-effective in Colombia for primary prevention in patients with 1.5PP characteristics.
Objective The mortality benefit of implantable cardioverter defibrillators (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) has been well-established, but ICD therapy remains globally underutilized. The results of the Improve SCA study showed a 49% relative risk reduction in all-cause mortality among ICD patients with 1.5 primary prevention (1.5PP) characteristics (patients with one or more risk factors, p < 0.0001). We evaluated the cost-effectiveness of ICD compared to no ICD therapy among patients with 1.5PP characteristics in three Latin American countries and analyzed the factors involved in cost-effectiveness.Methods We used a published Markov model that compares costs and outcomes of ICD to no ICD therapy from local payers’ perspective and included country-specific and disease-specific inputs from the Improve SCA study and current literature. We used WHO-recommended willingness-to-pay (WTP) thresholds to assess cost-effectiveness and compared model outcomes between countries.Results Incremental costs per QALY (quality-adjusted life year) saved by ICD compared to no ICD therapy are Colombian Pesos COP$46,729,026 in Colombia, Mexican Pesos MXN$246,016 in Mexico, and Uruguayan Pesos UYU$1,213,614 in Uruguay in the base case scenario; all three figures are between 1–3-times GDP per capita for each country. One-way and probabilistic sensitivity analyses confirm the base case scenario results. Non-cardiac accumulated deaths are lower in Mexico, resulting in a comparatively increased cost-effective ICD therapy.Limitations The Improve SCA study was not randomized, so clinical results could be biased; however, measures were taken to reduce this bias. Costs and benefits were modelled beyond the timeline of direct observation in the Improve SCA study.Conclusions ICD therapy is cost-effective in Mexico and Uruguay and potentially cost-effective in Colombia for a 1.5PP population. Variability in ICER estimates by country can be explained by differences in non-cardiac deaths and cost inputs.
No takes yet. Share an insight, caveat, or question.
Higuera et al. (2021) studied Primary prevention of sudden cardiac arrest. Implantable cardioverter defibrillator (ICD) therapy vs. No ICD therapy was evaluated on Incremental costs per QALY (quality-adjusted life year) saved. ICD therapy for primary prevention of sudden cardiac arrest is cost-effective in Mexico and Uruguay and potentially cost-effective in Colombia, with ICERs between 1-3 times GDP per capita.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: