OBJECTIVES: Implantable cardiac defibrillators (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) is well-established but underutilized globally. The IMPROVE SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP) based on PP patients with the presence of documented risk factors: non-sustained ventricular tachycardia, frequent premature ventricular contractions, left ventricular ejection fraction < 25%, and pre-syncope or syncope. This cohort could be used to prioritize health care resources in geographies where resources are scarce. We evaluated the cost-effectiveness of ICD therapy compared to no ICD among 1.5PP patients in Colombia.

METHODS: We modified inputs to a published Markov model to compare costs and outcomes of ICD therapy to no ICD. The model was run over a lifetime time horizon from the Colombian payer perspective. Mortality and utility estimates were obtained from the IMPROVE SCA study. Additional effectiveness inputs were sourced from the literature. Cost inputs were obtained from the Colombian authorities' price list, adjusted as suggested by local guidelines. Costs and quality-adjusted life years (QALYs) were discounted at 5.0%. We used a willingness-to-pay (WTP) value of between one (cost-effective) and three times (potentially cost-effective) Colombian GDP per capita in 2017.

RESULTS: The total discounted lifetime costs for ICD therapy were COP$ 132,937,748 (Colombian Peso) compared to COP$ 79,017,109 for no ICD therapy. Total discounted QALYs for ICD therapy and no ICD therapy were 6.20 and 5.04, respectively. The incremental cost effectiveness ratio was COP$ 46,729,029; therefore, ICD therapy should be considered potentially cost effective at a COP$ 56,484,299 WTP threshold.

CONCLUSIONS: ICD therapy compared to no ICD therapy is potentially cost-effective in the 1.5PP population in Colombia. A combination of global trial results and localized cost inputs provide a robust economic evaluation of this therapy in the Colombian health care system. These results may not be generalizable to other geographies.