Presentation (CTI)

OBJECTIVES: In the Dominican Republic, the national payer currently does not cover ICD implantation despite strong clinical evidence of benefit and existing ICD coverage in other Latin American countries. ICDs have been shown to be cost effective for standard primary prevention, and more so in 1.5 primary prevention (1.5PP) which includes additional risk factors. The purpose of this study was to estimate the cost effectiveness of ICD therapy in 1.5PP for the Dominican Republic.
METHODS: A Markov model was used to estimate costs and effects of ICD therapy vs. no ICD from a Dominican Republic national payer perspective. Data from the IMPROVE SCA trial was used for patient characteristics, quality of life, and ICD effectiveness. Data from secondary sources were used for probabilities of complication, therapy discontinuation, and patient utility. Localized inputs were mortality as drawn from publicly available life tables and cost estimates derived from the following institutions: Centro Cardioneuro Oftalmologico y Transplante, Asociacion Instituto Dominicano de Cardiologia, Centro Cardiovascular Santo Domingo, Clinica Corazones Unidos, and Hospital Metropolitano de Santiago. Costs and benefits were discounted at 3% per annum. The willingness-to-pay (WTP) value was three times the gross domestic product of the Dominican Republic in 2024.
RESULTS: The use of ICD therapy led to a gain of 2.53 quality adjusted life years (QALY) at an incremental cost of US$50,844 over a lifetime horizon. The discounted incremental cost effectiveness ratio (ICER) of ICD therapy over standard of care was US$20,115 per QALY, less than the WTP of US$35,070. The ICER remained lower than the WTP in 95% of the iterations in the probabilistic sensitivity analysis.
CONCLUSIONS: A combination of global trial results and localized cost inputs provide a robust economic evaluation of this therapy. It is reasonable to consider that ICD for 1.5PP is cost effective in the Dominican Republic.