1
|
Green N, Chen Y, O'Mahony C, Elliott PM, Barriales-Villa R, Monserrat L, Anastasakis A, Biagini E, Gimeno JR, Limongelli G, Pavlou M, Omar RZ. A cost-effectiveness analysis of hypertrophic cardiomyopathy sudden cardiac death risk algorithms for implantable cardioverter defibrillator decision-making. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:285-293. [PMID: 37660245 PMCID: PMC11238638 DOI: 10.1093/ehjqcco/qcad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/22/2023] [Accepted: 08/31/2023] [Indexed: 09/04/2023]
Abstract
AIMS To conduct a contemporary cost-effectiveness analysis examining the use of implantable cardioverter defibrillators (ICDs) for primary prevention in patients with hypertrophic cardiomyopathy (HCM). METHODS A discrete-time Markov model was used to determine the cost-effectiveness of different ICD decision-making rules for implantation. Several scenarios were investigated, including the reference scenario of implantation rates according to observed real-world practice. A 12-year time horizon with an annual cycle length was used. Transition probabilities used in the model were obtained using Bayesian analysis. The study has been reported according to the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Using a 5-year SCD risk threshold of 6% was cheaper than current practice and has marginally better total quality adjusted life years (QALYs). This is the most cost-effective of the options considered, with an incremental cost-effectiveness ratio of £834 per QALY. Sensitivity analyses highlighted that this decision is largely driven by what health-related quality of life (HRQL) is attributed to ICD patients and time horizon. CONCLUSION We present a timely new perspective on HCM-ICD cost-effectiveness, using methods reflecting real-world practice. While we have shown that a 6% 5-year SCD risk cut-off provides the best cohort stratification to aid ICD decision-making, this will also be influenced by the particular values of costs and HRQL for subgroups or at a local level. The process of explicitly demonstrating the main factors, which drive conclusions from such an analysis will help to inform shared decision-making in this complex area for all stakeholders concerned.
Collapse
Affiliation(s)
- Nathan Green
- Department of Statistical Science, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Yang Chen
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK
| | - Constantinos O'Mahony
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK
- St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK
- St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Cardiology Service, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC, CIBERCV), A Coruña 15006, Spain
| | - Lorenzo Monserrat
- Unidad de Cardiopatías Familiares, Cardiology Service, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC, CIBERCV), A Coruña 15006, Spain
| | - Aristides Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Leof. Andrea Siggrou 356, Kallithea 176 74, Greece
| | - Elena Biagini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Juan Ramon Gimeno
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia-Cartagenas, El Palmar, Murcia 30120, Spain
| | - Giuseppe Limongelli
- Monaldi Hospital, Second University of Naples, Via Leonardo Bianchi 1, Naples 80131, Italy
| | - Menelaos Pavlou
- Clinical Research Informatics Unit, University College London Hospitals, London NW1 2DA, UK
| | - Rumana Z Omar
- Clinical Research Informatics Unit, University College London Hospitals, London NW1 2DA, UK
| |
Collapse
|
2
|
Sun H, Liu X, Fu J, Song Y, Qin X, Wang H. Cost effectiveness of implantable cardioverter defibrillators for 1.5 primary prevention of sudden cardiac arrest in China: an analysis from the Improve SCA study. J Med Econ 2024; 27:575-581. [PMID: 38566556 DOI: 10.1080/13696998.2024.2333187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Implantable cardioverter defibrillator (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) is underutilized in developing countries. The Improve SCA study has identified a subset of 1.5 primary prevention (1.5PP) patients with a higher risk of SCA and a significant mortality benefit from ICD therapy. From the perspective of China's healthcare system, we evaluated the cost-effectiveness of ICD therapy vs. no ICD therapy among 1.5PP patients with a view to informing clinical and policy decisions. METHODS A published Markov model was adjusted and verified to simulate the course of the disease and describe different health states of 1.5PP patients. The patient characteristics, mortality, utility and complication estimates were obtained from the Improve SCA study and other literature. Cost inputs were sourced from government tender prices, medical service prices and clinical experts' surveys in 9 Chinese public hospitals. For both ICD and no ICD therapy, the total medical costs and quality-adjusted life-years (QALYs) were modelled over a lifetime horizon and the incremental cost-effectiveness ratio (ICER) was calculated. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. We used the willingness-to-pay (WTP) threshold recommended by China Guidelines for Pharmacoeconomic Evaluations, one to three times China's GDP per capita (CNY85,698-CNY257,094) in 2022 Chinese Yuan. RESULTS The incremental cost effectiveness ratio (ICER) of ICD therapy compared to no ICD therapy is 139,652 CNY/QALY, which is about 1-2 times China's GDP per capita. The probability that ICD therapy is cost effective was 92.1%. Results from sensitivity analysis supported the findings of the base case. CONCLUSIONS ICD therapy compared to no ICD therapy is cost-effective for the 1.5PP patients in China.
Collapse
Affiliation(s)
- Hui Sun
- Shanghai Medical Information Center, Shanghai Health Development Research Center, Shanghai, China
| | - Xin Liu
- Shanghai Medical Information Center, Shanghai Health Development Research Center, Shanghai, China
| | - Jin Fu
- Medtronic, Shanghai, China
| | | | - Xiaoxiao Qin
- Shanghai Medical Information Center, Shanghai Health Development Research Center, Shanghai, China
| | - Haiyin Wang
- Shanghai Medical Information Center, Shanghai Health Development Research Center, Shanghai, China
| |
Collapse
|
3
|
Begisbayev T, Kosherbayeva L, Gaitova K, Brimzhanova M. Cost-Effectiveness of Cardioverter-Defibrillator Implantation in Kazakhstan. Vasc Health Risk Manag 2022; 18:813-821. [PMID: 36281286 PMCID: PMC9587701 DOI: 10.2147/vhrm.s369953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/05/2022] [Indexed: 12/03/2022] Open
Abstract
ABSTRACT Cardiovascular disease is the leading cause of morbidity and mortality worldwide. The implementation of effective technologies such as Implantable cardioverter-defibrillator (ICD) for patients at risk of sudden cardiac death requires additional health system resources. OBJECTIVE To assess the economic effectiveness of ICD in comparison with conservative tactics for preventing life-threatening rhythm disturbances in Kazakhstan. METHODS A Markov model was built with a time horizon of 35 years. Mortality and utility data were obtained from the available literature. The economic parameters of the model are based on the approved tariffs for medical services in Kazakhstan and clinical protocols. Following WHO recommendations, a willingness to pay threshold of three times gross domestic product per capita was used to assess cost-effectiveness. A discount rate of 3.5% was applied to both costs and benefits. To deal with parameter uncertainties and to provide robust analysis, a probabilistic sensitivity analysis was performed, randomly varying all inputs subject to uncertainty assuming a statistical distribution. RESULTS The total costs in the primary prevention (PP) group by ICD implantation and in the control group were 8,903,786 tenges and 3,194,414 tenges, respectively. The discounted total quality-adjusted life-years saved (QALYs) in the ICD and control groups were 6.48 and 4.98, respectively. The indicator of incremental cost-effectiveness ratio amounted to3791604 tenge, which is below the willingness to pay threshold and indicates the cost-effectiveness of using ICD as a PP strategy in patients with sudden cardiac death risk factors in the health care of Kazakhstan. CONCLUSION The ICD for the primary prevention of the development of life-threatening rhythm disturbances and sudden cardiac death is a cost-effective health technology from the position of a payer in the health care system of Kazakhstan.
Collapse
Affiliation(s)
| | - Lyazzat Kosherbayeva
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan,Al-Farabi Kazakh National University, Almaty, Kazakhstan,Correspondence: Lyazzat Kosherbayeva, Asfendiyarov Kazakh National Medical University, 88 Tole bi Street, Almaty, Kazakhstan, Tel + 7 705 120 46 52, Email ;
| | - Kamilla Gaitova
- Health Technology Assessment Department, Republican Center for Health Development, Nur-Sultan, Kazakhstan
| | | |
Collapse
|
4
|
Zhang S, Chen WJ, Sankardas MA, Ahmed WH, Liew HB, Gwon HC, Nesa Malik FT, Tang B, Haggui A, Oh IY, Ong TK, Cheng CI, Liu X, Seth A, Choi YJ, Qamar N, Rungpradubvong V, Wang CC, Jeon J, Wong G, Lemme F, Van Dorn B, Lexcen D, Huang D. Improve the Prevention of Sudden Cardiac Arrest in Patients With Post-Acute Myocardial Infarction. JACC. ASIA 2022; 2:559-571. [PMID: 36518723 PMCID: PMC9743445 DOI: 10.1016/j.jacasi.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) implantation to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients varies by geography but remains low in many regions despite guideline recommendations. OBJECTIVES This study aimed to characterize the care pathway of post-MI patients and understand barriers to referral for further SCD risk stratification and management in patients meeting referral criteria. METHODS This prospective, nonrandomized, multi-nation study included patients ≥18 years of age, with an acute MI ≤30 days and left ventricular ejection fraction <50% ≤14 days post-MI. The primary endpoint was defined as the physician's decision to refer a patient for SCD stratification and management. RESULTS In total, 1,491 post-MI patients were enrolled (60.2 ± 12.0 years of age, 82.4% male). During the study, 26.7% (n = 398) of patients met criteria for further SCD risk stratification; however, only 59.3% of those meeting criteria (n = 236; 95% CI: 54.4%-64.0%) were referred for a visit. Of patients referred for SCD risk stratification and management, 94.9% (n = 224) attended the visit of which 56.7% (n =127; 95% CI: 50.1%-63.0%) met ICD indication criteria. Of patients who met ICD indication criteria, 14.2% (n = 18) were implanted. CONCLUSIONS We found that ∼40% of patients meeting criteria were not referred for further SCD risk stratification and management and ∼85% of patients who met ICD indications did not receive a guideline-directed ICD. Physician and patient reasons for refusing referral to SCD risk stratification and management or ICD implant varied by geography suggesting that improvement will require both physician- and patient-focused approaches. (Improve Sudden Cardiac Arrest [SCA] Bridge Study; NCT03715790).
Collapse
Key Words
- CRT-D, cardiac resynchronization therapy-defibrillator
- ICD, implantable cardioverter-defibrillator
- ISC, India subcontinent
- LVEF, left ventricular ejection fraction
- MEACAT, Middle East, Africa, Central Asia, and Turkey
- MI, myocardial infarction
- OR, odds ratio
- SCD, sudden cardiac death
- SEA, South East Asia
- cardiac resynchronization therapy–defibrillator
- delivery of health care
- implantable cardioverter-defibrillator
- myocardial infarction
Collapse
Affiliation(s)
- Shu Zhang
- Fu Wai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | - Houng-Bang Liew
- Clinical Research Centre, Queen Elizabeth Hospital II, Sabah, Malaysia
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Baopeng Tang
- Fu Wai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | | | - Il-Young Oh
- National Taiwan University Hospital, Taipei, Taiwan
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Cheng-I Cheng
- Kaohsiung Chang Gung Memorial Hospital of CGMF, Kaohsiung, Taiwan
| | - Xingbin Liu
- West China Hospital, Sichuan University, Chengdu, China
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | | | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Voravut Rungpradubvong
- Fortis Escorts Heart Institute, New Delhi, India
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chun-Chieh Wang
- Chang Gung Memorial Hospital Linkou and Chang Gung University, Taoyuan City, Taiwan
| | | | - Grace Wong
- Medtronic Australasia, Sydney, Australia
| | - Francesca Lemme
- National Taiwan University Hospital, Taipei, Taiwan
- Medtronic Bakken Research Center, Maastricht, the Netherlands
| | | | - Dan Lexcen
- National Taiwan University Hospital, Taipei, Taiwan
| | - Dejia Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | |
Collapse
|
5
|
Vo CN, Gold MR. Improving Primary Prevention of SCD With ICDs in Asia: One Size Does Not Fit All! JACC. ASIA 2022; 2:572-573. [PMID: 36624794 PMCID: PMC9823280 DOI: 10.1016/j.jacasi.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
| | - Michael R. Gold
- Address for correspondence: Dr Michael R. Gold, Department of Medicine, Division of Cardiology, Medical University of South Carolina, 114 Doughty Street, MSC 592, Charleston, South Carolina 29425-5920, USA.
| |
Collapse
|
6
|
Kudo T, Nessipkhan AE. Modalities for predicting events in patients with ICDs: Expanding the versatility of FDG PET. J Nucl Cardiol 2021; 28:478-480. [PMID: 33751471 DOI: 10.1007/s12350-021-02569-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Takashi Kudo
- Department of Radioisotope Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.
| | - Arman Erzhanovich Nessipkhan
- Department of Radioisotope Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| |
Collapse
|