Economic Evaluation Seminar - Cost-effectiveness of implantable cardioverter defibrillator for the primary prevention of patients post myocardial infarction
Event details
Abstract:
Background and Aims: This study aims to reassess the cost-effectiveness of implantable cardioverter defibrillators (ICDs) in addition to optimal medical therapy (OMT) for post-myocardial infarction patients with reduced left ventricular ejection fraction (LVEF) under the contemporary medication, updating results based on evidence from trials conducted more than two decades ago.
Methods: A cohort-based state-transition model was developed to compare ICD+OMT with OMT alone across eight subgroups defined by age, sex, and diabetes status, from the perspective of the National Health Service (NHS) and Personal Social Service (PSS) in England. Baseline mortality for OMT medication was informed by Swedish registry data and extrapolated in combination with general population mortality. Treatment effects of ICD were derived from structured expert elicitation. Costs and health-related quality of life were estimated using UK-specific sources, with published external sources where needed. Deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty.
Results: ICD+OMT was associated with increased costs and improved health outcomes across all subgroups. Cost-effectiveness varied substantially across subgroups and exceeded the threshold of £25,000/QALY. Young patients (<70), particularly males, experienced the greatest health gains; while old patients and those with diabetes derived smaller benefits. Sensitivity analysis suggested great variation across the expert-elicited treatment effects, followed by ICD device cost, and device replacement. Improvements in clinical effectiveness of ICD and reductions in ICD acquisition cost could enhance the cost-effectiveness of ICD therapy.
Conclusions: ICD implantation may no longer be considered cost-effective under the contemporary OMT from the NHS and PSS perspective in England.
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About the speaker
Yirui Qian, Research Fellow, Centre for Health Economics
Yirui Qian is a Research Fellow in the Economic Evaluation and Health Technology Assessment (TEEHTA) theme. She holds a MSc in Health Economics and Decision Modelling and a PhD that focuses on multiple statistical methods for the analysis of patient-reported outcomes in randomised controlled trials, both of which were obtained the from University of Sheffield.
Yirui’s research interests include the application of statistical methods for analysing health outcomes particularly patient-reported outcomes, cost-effectiveness analysis alongside trials, and decision analytic models. Yirui is also interested in a range of broad topics related to health economics modelling, including computationally intensive simulation, public health economic evaluation, approaches to incorporating social values (such as equity) into the process of health technology assessment and health benefit package design.
Yirui currently works on two projects: the health economic modelling for the PRevention Of sudden cardiac death aFter myocardial Infarction by Defibrillator implantation (the PROFID EHRA project) that reassesses the risk-benefits of implantable cardioverter-defibrillator in addition to optimal medical therapy; and the Healthy Urban Places (HUP-North) that aims to understand how to harness the power of local places to improve population health and reduce inequalities. Previously, Yirui worked on the Health Financing Universal Health Care in Challenging Times (HFACT project), where she developed her knowledge sets in bring social values into the HTA process using advanced method such as distribution cost-effectiveness analysis and cross-sectoral impact inventory.