Medtronic, plc, Dublin, Ireland.
Department of Cardiology, Taichung Veterans General Hospital and National Yan-Ming University School of Medicine, Taichung, Taiwan.
PLoS One. 2020 Nov 19;15(11):e0241697. doi: 10.1371/journal.pone.0241697. eCollection 2020.
Implantable cardiac defibrillators (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) are well-established but underutilized globally. The Improve SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP) based on PP patients with the presence of certain risk factors. We evaluated the cost-effectiveness of ICD therapy compared to no ICD among the PP population and the subset of 1.5PP patients in Taiwan.
A Markov model was run over a lifetime time horizon from the Taiwan payer perspective. Mortality and utility estimates were obtained from the literature (PP) and the IMPROVE SCA trial (1.5PP). Cost inputs were obtained from the Taiwan National Health Insurance Administration (NHIA), Ministry of Health and Welfare. We used a willingness-to-pay (WTP) threshold of NT$2,100,000, as established through standard WTP research methods and in alignment with World Health Organization recommendations.
The total discounted costs for ICD therapy and no ICD therapy were NT$1,664,259 and NT$646,396 respectively for PP, while they were NT$2,410,603 and NT$905,881 respectively for 1.5PP. Total discounted QALYs for ICD therapy and no ICD therapy were 6.48 and 4.98 respectively for PP, while they were 10.78 and 7.71 respectively for 1.5PP. The incremental cost effectiveness ratio was NT$708,711 for PP and NT$441,153 for 1.5PP, therefore ICD therapy should be considered cost effective for PP and highly cost effective for 1.5PP.
ICD therapy compared to no ICD therapy is cost-effective in the whole PP population and highly cost-effective in the subset 1.5PP population in Taiwan.
植入式心脏除颤器（ICD）用于预防心脏性猝死（SCA）的一级预防（PP）已得到广泛认可，但在全球范围内的应用不足。“改善 SCA 研究”根据存在某些危险因素的 PP 患者确定了一个名为 1.5 级预防（1.5PP）的患者队列。我们评估了 ICD 治疗在台湾的 PP 人群和 1.5PP 亚组人群中的成本效益。
从台湾支付者的角度，使用 Markov 模型进行了终生时间范围内的计算。死亡率和效用估计值来自文献（PP）和 IMPROVE SCA 试验（1.5PP）。成本投入数据来自台湾国家健康保险管理局（NHIA）和卫生福利部。我们使用了 2100 万新台币的意愿支付（WTP）阈值，这是通过标准的 WTP 研究方法确定的，与世界卫生组织的建议一致。
PP 人群中，ICD 治疗和无 ICD 治疗的总贴现成本分别为新台币 1664259 元和 646396 元，而 1.5PP 人群中的成本分别为新台币 2410603 元和 905881 元。PP 人群中，ICD 治疗和无 ICD 治疗的总贴现 QALYs 分别为 6.48 和 4.98，而 1.5PP 人群中的 QALYs 分别为 10.78 和 7.71。增量成本效益比为新台币 708711 元用于 PP，新台币 441153 元用于 1.5PP，因此，ICD 治疗在整个 PP 人群中具有成本效益，在 1.5PP 亚组人群中具有极高的成本效益。
与无 ICD 治疗相比，ICD 治疗在台湾的整个 PP 人群中具有成本效益，在 1.5PP 亚组人群中具有极高的成本效益。
