Cost effectiveness of implantable cardioverter defibrillators for 1.5 primary prevention of sudden cardiac arrest in China: an analysis from the Improve SCA study

Figures & data

Figure 1. Markov model structure.

Table 1. Transition probabilities.

Parameters	Base case value	Standard error	Data sources
ICD therapy group
Monthly mortality risk
Sudden cardiac death	0.0007	0.0003	6
Non-sudden cardiac death	0.0014	0.0004	6
Non-cardiac death	0.0005	0.0003	6
Unknown death	0.0013	0.0003	6
Operative death rate	0.00020	0.00002	11
ICD-related complications-continue ICD	0.0034	0.0002	15–18,22
ICD-related complications-discontinue ICD	0.0001	0.00007	15–18,22
Lead replacement (initial implant)	0.0004	0.0005	12,13
Lead replacement (replacement implant)	0.0008	0.0009	14
Lead dislodgement (initial implant)	0.018	0.0012	13
Lead dislodgment (replacement implant)	0.005	0.0009	15
ICD infection (initial implant)	0.0244	0.0049	19,20
ICD infection (replacement implant)	0.0432	0.0064	19,20
No ICD therapy group
Monthly mortality risk
Sudden cardiac death	0.0028	0.0005	6
Non-sudden cardiac death	0.0021	0.0004	6
Non-cardiac death	0.0010	0.0004	6
Unknown death	0.0014	0.0004	6

Table 2. Cost inputs.

Cost	Base case value (CNY)	Range	Data sources
Initial ICD implant cost	111,830	±25%	Expert survey
ICD replacement cost	98,727	±25%	Expert survey
ICD complication treatment costs per event (inappropriate shocks)	670	±25%	Expert survey
Post-operative follow-up costs per month	133	±25%	Expert survey
Costs of ICD infection treatment per event (complete device removal)	200,000	±25%	Expert survey
Cost of lead dislodgment treatment per event	3000	±25%	Expert survey
Long-term inpatient costs per month	1917	±25%	Expert survey
Long-term outpatient costs per month	644	±25%	estimated from tender prices listed by government

Table 3. Utilities.

Utility	Initial value	Standard error	Data source
Annual Utility	0.837	0.0007	23
ICD Complication State	0.7408	0.0112	23,24
Death State	0	0	Assumption

Table 4. Base case results.

Treatment arm	Base case results		ICER
	Total costs (CNY)	Achieved QALYs (CNY)
Undiscounted
ICD therapy	656,001	11.63	–
No ICD therapy	293,928	8.30	Comparator
Incremental	362,073	3.33	108,769CNY/QALY
Discounted
ICD therapy	471,360	7.02	–
No ICD therapy	215,673	6.09	Comparator
Incremental	255,687	1.83	139,652CNY/QALY

Figure 2. One-way deterministic sensitivity analysis results.

Figure 3. Scatter plot of incremental cost-effectiveness ratios.

Figure 4. Cost-effectiveness acceptability curve.