[Cost effectiveness of implantable cardioverter-defibrillators for patients who are at risk for sudden death in Argentina].

OBJECTIVE

To evaluate the cost-effectiveness and cost-utility of the cardioverter-defibrillator (ICD) among patients who are at risk for sudden death in Argentina, from three scenarios: public health, social security and private sector.

METHODS

We developed a Markov model to evaluate the survival, quality of life and cost of the prophylactic implantation of an ICD, as compared with pharmacological therapy, among three different target populations according to clinical trials selected using a systematic review, and choosing epidemiological, effectiveness, resource use and cost parameters. A healthcare system perspective was adopted. A 3% discount rate was used.

RESULTS

The use of the ICD was more costly and more effective than control therapy. The cohort with greater benefits was represented by MADIT I study, showing an incremental cost effectiveness rate (ICER) of $8,539 (dollar 2009) for public, $9,371 for social security and $10,083 for private sector. ICERs for secondary prevention population were $21,016, $22,520 and $24,012, and for MADIT II population were $17,379, $18,574 and $19,799. The analysis was robust to different deterministic and probabilistic sensitivity analyses, except for the cost of ICD and for battery life.

CONCLUSIONS

The results varied considerably depending on the cohort and discretely according to the health system. ICD could be cost-effective in Argentina, mainly in the MADIT I patients.