OBJECTIVES: The mortality benefits of implantable cardioverter defibrillators (ICDs) for the primary prevention (PP) of sudden cardiac arrest (SCA) are well-established, but ICD therapy remains underutilized worldwide. In this study, we evaluated the cost-effectiveness of ICD versus drug therapy among patients with PP characteristics from the perspective of the Chinese health system.

METHODS: A Markov model was developed to describe different health states of patients after treatment with ICD and drug therapy. The patient characteristics, efficacy, treatment complications, and utilities were obtained from the literature. The costs were based on the tender price listed by government and the results of cost surveys of fifteen local clinicians from different demographic parts of China. For each therapy, the total lifetime costs and quality-adjusted life-years (QALYs) were modelled, and the incremental cost-effectiveness ratio (ICER) was calculated. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. We used the willingness-to-pay (WTP) threshold of $37,260 (3 times China’s GDP per capita) per QALY gained based on WHO recommendations.

RESULTS: In the base case analysis, the lifetime treatment costs for ICD and drug therapy were the $55,586 and $25,210, respectively. The total QALYs for ICD and drug therapy were 5.89 QALYs and 4.74 QALYs, respectively. ICD therapy resulted in an ICER of $26,466/QALY. Therefore, it is a cost-effective strategy compared to drug therapy for the primary prevention population. This result was also validated by one-way and probabilistic sensitivity analysis, in which ICD remained the most cost-effective option.

CONCLUSIONS: ICD therapy compared to drug therapy is cost-effective for primary prevention population in China.