OBJECTIVES: The Improve SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP) based on PP population with the presence of certain risk factors, and the results showed a 49% relative risk reduction in all-cause mortality among those ICD implanted 1.5PP patients. In this study, we assessed the cost-effectiveness of ICD compared to drug therapy among 1.5PP patients from the Chinese payer perspective.

METHODS: A Markov model, using a 1-month cycle over a lifetime horizon, was developed to describe different health states of patients after treatment with ICD and drug therapy. The disease-specific clinical inputs and utilities were obtained from the Improve SCA study and current literature. The costs were based on the tender price published by government and the results of cost surveys of fifteen local clinicians from different demographic parts of China. For each therapy, we modelled the total costs and quality-adjusted life-years (QALYs), and then calculated incremental the cost-effectiveness ratio (ICER). According to the WHO recommendation, therapies were evaluated with the willingness-to-pay (WTP) threshold of $37,260 (3 times China’s GDP per capita) per QALY gained.

RESULTS: In the base case of lifetime horizon, the total discounted costs and QALYs for ICD therapy were $68,313 and 7.92 QALYs, whereas drug therapy was associated with the cost of $31,258 and 6.09 QALYs. The ICER was $20,239/QALY, below 2 times China’s GDP per capita. Therefore, ICD therapy is a cost-effective strategy compared to drug therapy for the 1.5PP patients. This result was validated by sensitivity analysis, in which ICD therapy remained the cost-effective option.

CONCLUSIONS: Compared to drug therapy, ICD therapy is cost-effective in the 1.5PP population in China.