Evaluating the Budgetary Impact of the Wearable Cardioverter Defibrillator Service for Patients at Risk of Sudden Cardiac Death in the United Kingdom
Author(s)
Vladica M. Velickovic, PhD, MD1, Xiaoyang Du, BA, MPH, MSc2, Jelena SAvovic, PhD3, Tamara Jovanovic, MD, PhD4, Milica Krga, MSc4, Brigitte Both, PhD5, Farai Goromonzi, MBA, MSc5.
1Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall, Triol, Austria, 2Evidence Synthesis Department, Biomath Models, London, United Kingdom, 3Bristol Population Health Science Institute, Bristol, United Kingdom, 4Biomath Models, London, United Kingdom, 5ZOLL Medical UK Ltd, Cheshire, United Kingdom.
1Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall, Triol, Austria, 2Evidence Synthesis Department, Biomath Models, London, United Kingdom, 3Bristol Population Health Science Institute, Bristol, United Kingdom, 4Biomath Models, London, United Kingdom, 5ZOLL Medical UK Ltd, Cheshire, United Kingdom.
Presentation Documents
OBJECTIVES: The objective of this study is to evaluate the budgetary impact of implementing the LifeVest® wearable cardioverter defibrillator (WCD) service (Zoll Medical) in the English National Health Service (NHS) from the payer's perspective.
METHODS: The Budget Impact Model (BIM) was developed in accordance with ISPOR and UK best practice guidelines, utilizing a system of deterministic decision trees for each subpopulation that aligns with subpopulation-specific treatment pathways within the NHS system. The model evaluates three patient populations at high risk of sudden cardiac death (SCD) following acute myocardial infarction (AMI): (1) revascularized patients, (2) non-revascularized patients, and (3) patients with a predetermined SCD risk who clinically require implantable cardioverter-defibrillator (ICD) explantation. The intervention, comprising the UK standard guideline-directed medical therapy (GDMT) plus the WCD, was compared to the UK GDMT alone, with a time horizon of one year. Input data include incidence, mortality, treatment complications, resource use, costs, and sustainability metrics. These inputs and assumptions were informed by systematic reviews of relevant clinical and health economic literature, real-world data from Hospital Episode Statistics, and UK-specific treatment guidelines. Sensitivity analyses were conducted to address uncertainties, and the BIM was validated.
RESULTS: The model projects that implementing WCD alongside GDMT results in a total cost of £16,583 per patient annually, compared to £16,802 for GDMT alone, yielding a total budget impact of -£219 per patient annually. Additionally, the use of WCD reduces CO2 emissions by 1,161 kg per patient compared to GDMT alone (947 kg vs. 2,109 kg), contributing to environmental sustainability goals. Potential savings for the NHS budget are projected to be £23,244,660 annually.
CONCLUSIONS: According to projections from this model, the WCD can range from cost-neutral to cost-saving for the NHS. While the results are cost-neutral in revascularized and non-revascularized post-AMI patients, the ICD explantation subpopulation demonstrates cost-saving outcomes.
METHODS: The Budget Impact Model (BIM) was developed in accordance with ISPOR and UK best practice guidelines, utilizing a system of deterministic decision trees for each subpopulation that aligns with subpopulation-specific treatment pathways within the NHS system. The model evaluates three patient populations at high risk of sudden cardiac death (SCD) following acute myocardial infarction (AMI): (1) revascularized patients, (2) non-revascularized patients, and (3) patients with a predetermined SCD risk who clinically require implantable cardioverter-defibrillator (ICD) explantation. The intervention, comprising the UK standard guideline-directed medical therapy (GDMT) plus the WCD, was compared to the UK GDMT alone, with a time horizon of one year. Input data include incidence, mortality, treatment complications, resource use, costs, and sustainability metrics. These inputs and assumptions were informed by systematic reviews of relevant clinical and health economic literature, real-world data from Hospital Episode Statistics, and UK-specific treatment guidelines. Sensitivity analyses were conducted to address uncertainties, and the BIM was validated.
RESULTS: The model projects that implementing WCD alongside GDMT results in a total cost of £16,583 per patient annually, compared to £16,802 for GDMT alone, yielding a total budget impact of -£219 per patient annually. Additionally, the use of WCD reduces CO2 emissions by 1,161 kg per patient compared to GDMT alone (947 kg vs. 2,109 kg), contributing to environmental sustainability goals. Potential savings for the NHS budget are projected to be £23,244,660 annually.
CONCLUSIONS: According to projections from this model, the WCD can range from cost-neutral to cost-saving for the NHS. While the results are cost-neutral in revascularized and non-revascularized post-AMI patients, the ICD explantation subpopulation demonstrates cost-saving outcomes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE520
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)