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The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis

(2013) EUROPEAN HEART JOURNAL. 34(3). p.211-219
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Abstract
It remains unclear whether primary prophylactic implantable cardioverter-defibrillator (ICD) therapy is cost-effective compared with a ono ICD strategy' in the European health care setting. We performed a cost-effectiveness analysis for a cohort of patients with a left ventricular ejection fraction 40 and ischaemic or non-ischaemic heart disease. A Markov decision analytic model was used to evaluate long-term survival, quality-adjusted life years (QALYs), and lifetime costs for a cohort of patients with a reduced left ventricular function without previous arrhythmias, managed with a prophylactic ICD. Input data on effectiveness were derived from a meta-analysis of primary prophylactic ICD-only therapy randomized trials, from a prospective cohort study of ICD patients, from a health care utilization survey, and from the literature. Input data on costs were derived from a micro-cost analysis. Data on quality-of-life were derived from the literature. Deterministic and probabilistic sensitivity analysis was performed to assess the uncertainty. Probabilistic sensitivity analysis demonstrated a mean lifetime cost of Euro50 685 Euro4604 and 6.26 0.64 QALYs for patients in the ono ICD strategy'. Patients in the oICD strategy' accumulated Euro86 759 Euro3343 and an effectiveness of 7.08 0.71 QALYs yielding an incremental cost-effectiveness ratio of Euro43 993/QALY gained compared with the ono ICD strategy'. The probability that ICD therapy is cost-effective was 65 at a willingness-to-pay threshold of Euro80 000/QALY. Our results suggest that primary prophylactic ICD therapy in patients with a left ventricular ejection fraction 40 and ischaemic or non-ischaemic heart disease is cost-effective in the European setting.
Keywords
Coronary artery disease, Dilated cardiomyopathy, Primary prevention, Cost-effectiveness, Implantable cardioverter-defibrillator, LEFT-VENTRICULAR DYSFUNCTION, REDUCED EJECTION FRACTION, CARDIOVERTER-DEFIBRILLATOR, MYOCARDIAL-INFARCTION, DEATH, TRIAL, PREVENTION, RISK, CARDIAC-RESYNCHRONIZATION THERAPY, FAILURE

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Chicago
Smith, Tim, Luc Jordaens, Dominic AMJ Theuns, Pascal F van Dessel, Arthur A Wilde, and MG Myriam Hunink. 2013. “The Cost-effectiveness of Primary Prophylactic Implantable Defibrillator Therapy in Patients with Ischaemic or Non-ischaemic Heart Disease: a European Analysis.” European Heart Journal 34 (3): 211–219.
APA
Smith, Tim, Jordaens, L., Theuns, D. A., van Dessel, P. F., Wilde, A. A., & Hunink, M. M. (2013). The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis. EUROPEAN HEART JOURNAL, 34(3), 211–219.
Vancouver
1.
Smith T, Jordaens L, Theuns DA, van Dessel PF, Wilde AA, Hunink MM. The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis. EUROPEAN HEART JOURNAL. 2013;34(3):211–9.
MLA
Smith, Tim et al. “The Cost-effectiveness of Primary Prophylactic Implantable Defibrillator Therapy in Patients with Ischaemic or Non-ischaemic Heart Disease: a European Analysis.” EUROPEAN HEART JOURNAL 34.3 (2013): 211–219. Print.
@article{8101316,
  abstract     = {It remains unclear whether primary prophylactic implantable cardioverter-defibrillator (ICD) therapy is cost-effective compared with a ono ICD strategy' in the European health care setting. We performed a cost-effectiveness analysis for a cohort of patients with a left ventricular ejection fraction 40 and ischaemic or non-ischaemic heart disease. 
A Markov decision analytic model was used to evaluate long-term survival, quality-adjusted life years (QALYs), and lifetime costs for a cohort of patients with a reduced left ventricular function without previous arrhythmias, managed with a prophylactic ICD. Input data on effectiveness were derived from a meta-analysis of primary prophylactic ICD-only therapy randomized trials, from a prospective cohort study of ICD patients, from a health care utilization survey, and from the literature. Input data on costs were derived from a micro-cost analysis. Data on quality-of-life were derived from the literature. Deterministic and probabilistic sensitivity analysis was performed to assess the uncertainty. Probabilistic sensitivity analysis demonstrated a mean lifetime cost of Euro50 685 Euro4604 and 6.26 0.64 QALYs for patients in the ono ICD strategy'. Patients in the oICD strategy' accumulated Euro86 759 Euro3343 and an effectiveness of 7.08 0.71 QALYs yielding an incremental cost-effectiveness ratio of Euro43 993/QALY gained compared with the ono ICD strategy'. The probability that ICD therapy is cost-effective was 65 at a willingness-to-pay threshold of Euro80 000/QALY. 
Our results suggest that primary prophylactic ICD therapy in patients with a left ventricular ejection fraction 40 and ischaemic or non-ischaemic heart disease is cost-effective in the European setting.},
  author       = {Smith, Tim and Jordaens, Luc and Theuns, Dominic AMJ and van Dessel, Pascal F and Wilde, Arthur A and Hunink, MG Myriam},
  issn         = {0195-668X},
  journal      = {EUROPEAN HEART JOURNAL},
  keywords     = {Coronary artery disease,Dilated cardiomyopathy,Primary prevention,Cost-effectiveness,Implantable cardioverter-defibrillator,LEFT-VENTRICULAR DYSFUNCTION,REDUCED EJECTION FRACTION,CARDIOVERTER-DEFIBRILLATOR,MYOCARDIAL-INFARCTION,DEATH,TRIAL,PREVENTION,RISK,CARDIAC-RESYNCHRONIZATION THERAPY,FAILURE},
  language     = {eng},
  number       = {3},
  pages        = {211--219},
  title        = {The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehs090},
  volume       = {34},
  year         = {2013},
}

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