Table 4.
Selected economic evaluations of implantable cardioverter defibrillator and cardiac resynchronization therapy devices.
| Study (Year) | Patient population | Analysis/Methodology | Country | Intervention vs. Comparator | Time Horizon | Currency | Incremental Cost Effectiveness Ratio | Reference |
|---|---|---|---|---|---|---|---|---|
| Implantable Cardioverter Defibrillators—Primary Prevention | ||||||||
| Sanders (2005) | Primary prevention device in LV dysfunction | CEA and CUA/Markov decision model | United States | ICD vs. Medical therapy | Lifetime | 2005 USD | $24,500–$50,700/LY $34,000–$70,200/QALY |
(80) |
| Mark (2006) | Primary Prevention; Patients with LV dysfunction with EF <35%, NYHA Class II-III | CEA and CUA/Trial-based | United States | ICD vs. Medical therapy | Lifetime | 2003 USD | $38,389/LY $41,530/QALY |
(79) |
| Smith (2013) | Primary Prevention; Patients with LV dysfunction, EF <40% | CUA/Markov decision model | United Kingdom | ICD vs. no ICD | Lifetime | 2010 Euro | €43,993/QALY | (82) |
| Implantable Cardioverter Defibrillators—Secondary Prevention | ||||||||
| O’Brien (2001) | Secondary prevention; Patients surviving VT/VF | CEA/Trial-based | Canada | ICD vs. amiodarone | 6 years | 1999 CDN | $214,543/LY | (78) |
| Larsen (2002) | Secondary prevention; Patients resuscitated from cardiac arrest or ventricular tachycardia causing syncope or severe hemodynamic impairment and EF ≤0.40 | CEA/Trial-based | United States | ICD vs. antiarrhythmic therapy | 4 years | 1997 USD | $66,677/LY | (83) |
| Cardiac Resynchronization Therapy | ||||||||
| Feldman (2005) | Patients with symptomatic HF (NYHA class III/IV), EF ≤35%, QRS ≥120 ms, PR >150 ms, HF hospitalization within 1 year | CUA/Markov decision model | United States | CRT-P or CRT-D vs. medical therapy | 7 years | 2004 USD | $19,600/QALY (CRT-P) $43,000/QALY (CRT-D) |
(84) |
| Noyes (2013) | Minimally symptomatic (NYHA I/II)HF, QRS >130 ms, EF <30% | CUA/Trial-based | United States | CRT vs. ICD | 4 years | 2008 USD | $58,330/QALY (full cohort) $16,640/QALY (LBBB subgroup) |
(85) |
| Woo (2015) | Patients with mild HF (NYHA class I/II), QRS >120 ms, EF <30% | CUA/Markov decision model | United States | CRT-D vs. ICD alone | Lifetime | 2014 USD | $61,700/QALY | (86) |
CDN, Canadian; CRT-D, cardiac resynchronization therapy defibrillator; CRT-P, cardiac resynchronization therapy pacemaker; CUA, cost utility analysis; ICD, implantable cardioverter defibrillator; EF, ejection fraction; HF, heart failure; QALY, quality adjusted life years; LV, left ventricular; LY, life years; NYHA, New York Heart Association; VF, ventricular fibrillation; VT, ventricular tachycardia.