Cost-utility analysis of the implantable cardioverter defibrillator for the treatment of Colombian patients with class II or III ischemic or non-ischemic heart failure according to the New York Heart Association

Cost-utility analysis of the implantable cardioverter defibrillator for the treatment of Colombian patients with class II or III ischemic or non-ischemic heart failure according to the New York Heart Association

Drag. Clara Saldarriaga
Sara Atehortúa, Juan Manuel Senior, Paula Castro, Mateo Ceballos, Clara Saldarriaga, Nelson giraldo, Guillermo Mora
Biomedical
Publication date: 09/2019

Summary

Introduction. The use of the implantable cardioverter defibrillator reduces the probability of sudden death in patients with heart failure.
objective. To determine the cost-utility ratio of an implantable cardioverter-defibrillator compared to optimal drug therapy for patients
with ischemic or non-ischemic heart failure class II or III according to theNew York Heart Association (NYHA II-III) In colombia.
Materials and methods. A Markov model was developed that included the costs, effectiveness and quality of life from the perspective of the Colombian health system. For the base case, a time horizon of 10 years and a discount rate of 3 % for costs and a 3,5 % for benefits. Transition probabilities were obtained from a systematic review of the literature.. Quality-adjusted life years were used as health outcome. To estimate the unit costs, national tariff manuals were used and, for device costs, the manufacturers that sell it in the Colombian market were consulted. Probabilistic and deterministic sensitivity analyzes were performed.
Results. In the base case, the additional cost per quality-adjusted life year gained with the implantable cardioverter defibrillator was USD $ 13,187. Using a threshold of three times per capita gross domestic product as a reference (USD$ 19.139 in 2017), the device would be cost-effective for the Colombian health system. However, this result depends on the time horizon, of the probability of death and the price of the device.
Conclusions. The use of an implantable cardioverter defibrillator would be a cost-effective strategy for Colombia, although the results should be examined taking into account the uncertainty.

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