Kontogiannis Vasileios, Goromonzi Farai, Both Brigitte, Semrau Frank, Branagan-Harris Michael, Atkinson Jowan, Roberts Paul R, Javanbakht Mehdi
Optimax Access Ltd, Kenneth Dibben House, Enterprise Rd, Chilworth, Southampton University Science Park, Southampton, UK.
ZOLL Medical UK Ltd, Cheshire, UK.
Pharmacoecon Open. 2025 Mar;9(2):301-312. doi: 10.1007/s41669-024-00553-z. Epub 2025 Jan 24.
Patients with a left ventricular ejection fraction ≤ 35% are at increased risk of sudden cardiac death (SCD) within the first months after a myocardial infarction (MI). The wearable cardioverter defibrillator (WCD) is an established, safe and effective solution which can protect patients from SCD during the first months after an MI, when the risk of SCD is at its peak. This study aimed to evaluate the cost-effectiveness of WCD combined with guideline-directed medical therapy (GDMT) compared to GDMT alone, after MI in the English National Health Service (NHS).
A multi-state Markov model, with a hypothetical cohort of 1000 patients, was developed to evaluate WCD + GDMT compared with GDMT alone, over a lifetime time horizon. Model input parameters were obtained from the pivotal randomised controlled trial and literature. The outcomes were costs and quality-adjusted life-years (QALYs), discounted at 3.5% annually, with overall results presented as an incremental cost-effectiveness ratio (ICER).
The cost-effectiveness analysis demonstrated that WCD + GDMT is potentially a cost-effective option with an ICER of £23,024 per QALY gained, which is in the acceptable willingness to pay threshold (WTP) range of £20,000-£30,000 set by the National Institute for Health and Care Excellence (NICE) in England. Results of probabilistic sensitivity analysis (PSA) indicated that WCD + GDMT has 89.3% and 23% probability of being cost-effective at WTP thresholds of £30,000 and £20,000, respectively.
Implementation of WCD in patients post-MI is potentially a cost-effective use of resources for the NHS and improves clinical outcomes amongst adherent patients and in circumstances where implantable cardioverter defibrillators are not indicated by the guidelines.
左心室射血分数≤35%的患者在心肌梗死（MI）后的头几个月内发生心源性猝死（SCD）的风险增加。可穿戴式心脏复律除颤器（WCD）是一种成熟、安全且有效的解决方案，可在MI后的头几个月内保护患者免受SCD的影响，此时SCD风险处于峰值。本研究旨在评估在英国国家医疗服务体系（NHS）中，WCD联合指南导向药物治疗（GDMT）与单独使用GDMT相比，在MI后的成本效益。
建立了一个多状态马尔可夫模型，以1000名患者的假设队列来评估WCD + GDMT与单独使用GDMT相比在整个生命周期内的情况。模型输入参数来自关键随机对照试验和文献。结果指标为成本和质量调整生命年（QALY），按每年3.5%进行贴现，总体结果以增量成本效益比（ICER）表示。
成本效益分析表明，WCD + GDMT可能是一种具有成本效益的选择，每获得一个QALY的ICER为23,024英镑，处于英国国家卫生与临床优化研究所（NICE）设定的20,000 - 30,000英镑可接受支付意愿阈值（WTP）范围内。概率敏感性分析（PSA）结果表明，在WTP阈值为30,000英镑和20,000英镑时，WCD + GDMT具有成本效益的概率分别为89.3%和23%。
在MI后患者中实施WCD对NHS而言可能是一种具有成本效益的资源利用方式，并可改善依从性患者的临床结局，以及在指南未表明适合植入式心脏复律除颤器的情况下。
