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 Brazil.

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 Brazilian payer perspective. Mortality and utility estimates were obtained from the IMPROVE SCA trial. Additional effectiveness inputs were sourced from the literature. Cost inputs were obtained from the Unified Health System and Brazilian Ministry of Health. Costs were discounted at 4.7%; quality-adjusted life years (QALYs) were discounted at 1.45%. We used a willingness-to-pay (WTP) value of three times Brazil gross domestic product in 2017.

RESULTS : The total discounted lifetime costs for ICD therapy were R$100,782 (Brazilian Real) compared to R$43,986 for no ICD therapy. Total discounted QALYs for ICD therapy and no ICD therapy were 9.8 and 7.15, respectively. The incremental cost effectiveness ratio was R$21,453, therefore ICD therapy should be considered highly cost effective at a R$115,044 WTP threshold. Results from sensitivity analyses were consistent with base case results.

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