1389. Economic Evaluation of Universal Varicella Vaccination in Mexico

Abstract Background Universal varicella vaccination (UVV) has proven to be cost-effective in countries where implemented. However, this has not yet been evaluated for Mexico. We assessed the cost-effectiveness of UVV in the Mexican Immunization Program from both healthcare and societal perspectives. Methods The annual disease burden (varicella cases/deaths, outpatient visits, and hospitalizations) were derived from Mexican seroprevalence-published data adjusted to the 2020 country’s population. The annual economic burden was calculated by combining disease with Mexican published unit cost data. Four different vaccination strategies were evaluated: 1. One dose of a single varicella vaccine at 1 year old; 2. Two doses of single varicella vaccine at 1 and 6 years; 3. One dose of a single varicella vaccine at 1 year, and quadrivalent measles-mumps-rubella-varicella vaccine (MMRV) at 6 years; 4. Two doses of MMRV at 1 and 6 years. We developed an economic model for each vaccination strategy where 20 consecutive birth cohorts were simulated. The impact of vaccination (number of avoided cases/deaths) was evaluated for a 20 years follow-up period based on vaccine effectiveness (87% and 97.4%), and assuming a 95% coverage. Subsequently, we estimated net vaccination costs, benefit-cost ratio (BCR), annual costs saved, cost-effectiveness ratio. Results From annual disease burden estimation, avoided cases with one dose, and two doses were of 20,570,722 and 23,029,751, respectively. From the 20 years cohort, the yearly number of varicella cases was estimated at 2,041,296, and total costs at $115,565,315 (USD) (healthcare perspective) and $165,372,061 (healthcare and societal perspectives). Strategies 1 and 2 were found to be cost-saving (BCR >1) (Figure 1), and strategy 3 to be cost-effective (CE) ($1539 per Life Year Gained). Strategy 4 was not CE. Strategies 1 and 2 would allow saving annually $53.16 million and $34.41 million, respectively, to the Mexican society. FIGURE 1 Conclusion 1.The disease and economic burden of varicella in Mexico are high. 2.UVV with four different vaccination strategies results in a high reduction of cases. 3.From healthcare and societal perspectives, UVV was shown to be cost-effective (with strategy 3), and cost-saving (with strategies using one dose or two doses separately). Disclosures All Authors: No reported disclosures

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Estimating the Health and Economic Impact of Universal Varicella Vaccination in Jordan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.721 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S309-S310

Author(s):

Wail Hayajneh ◽

Mohammad Al Abdullat ◽

Abdalla Al Shurman ◽

Jihane Maalouf ◽

Barbara Kuter ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Economic Impact ◽

Societal Perspective ◽

Indirect Costs ◽

Cost Effective ◽

Childhood Vaccination ◽

Varicella Vaccination ◽

Direct And Indirect Costs ◽

The Impact

Abstract Background To evaluate the impact of adding universal varicella vaccination (UVV) to the existing childhood vaccination programme in Jordan, and identify the most cost-effective strategy. Methods A dynamic transmission model of varicella infection was calibrated to available varicella seroprevalence data within the region and validated against local epidemiological data. Local direct and indirect costs and healthcare utilization data were used. We considered the health and economic impact of one dose UVV administered concurrently with MMR at 12 months of age with 95% coverage, and two dose strategies with short (6 month) and long (4 year) intervals between First and Second dose. We took the societal perspective (direct and indirect costs) and discounted costs and QALYs by 3%/year to assess cost-effectiveness. Results The model estimated the current burden of varicella at 172,000 cases/year, an incidence rate of 2,200/100,000 persons. In the 5th/25th year after vaccination, all strategies substantially reduced total varicella incidence by 89.5%/96.6% (1 dose), 92.3%/98.0% (2 dose short), and 90.5%/98.3% (2 dose long), compared with no vaccine (Figure 1). In the absence of vaccination, an estimated $47.89 M ($28.81 M direct, $19.08 indirect) was spent annually on varicella treatment. The average annual total treatment costs over 25 years from the societal perspective were $4.01M (1 dose), $3.34M (2 dose short), and $3.43M (2 dose long). Considering a willingness to pay (WTP) threshold of $3,600 USD / QALY and the societal perspective, the 1 dose program was the most cost-effective with cost savings of $83.40 USD and health gain of 4.127 × 10−5 QALYs per person. 2 dose programs are similarly cost-saving and highly effective, compared with a scenario of no vaccination; however, moving incrementally from a 1 dose strategy, incremental cost-effectiveness ratios (ICERS) were $6.9M/QALY (short vs. 1 dose) and $13.5M/QALY (long vs. short), both well as above the WTP threshold. All strategies reached. Conclusion One or two dose UVV in Jordan will significantly reduce varicella disease burden and is cost saving relative to no vaccine over 25 years. Disclosures W. Hayajneh, Merck & Co., Inc.: Consultant, Consulting fee. J. Maalouf, Merck & Co., Inc.: Employee, Salary. B. Kuter, Merck & Co., Inc.: Employee, Salary.T. Weiss, Merck & Co., Inc.: Employee, Salary. V. Daniels, Merck & Co., Inc.: Employee, Salary. L. Wolfson, Merck & Co., Inc.: Employee, Salary.

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Clinical and economic impact of universal varicella vaccination in Norway: A modeling study

PLoS ONE ◽

10.1371/journal.pone.0254080 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254080

Author(s):

Manjiri Pawaskar ◽

Colleen Burgess ◽

Mathew Pillsbury ◽

Torbjørn Wisløff ◽

Elmira Flem

Keyword(s):

Cost Saving ◽

Varicella Vaccine ◽

Vaccination Strategy ◽

Quadrivalent Vaccine ◽

Transmission Model ◽

Varicella Vaccination ◽

Vaccination Strategies ◽

Dynamic Transmission Model ◽

Life Years ◽

The Impact

Background Norway has not implemented universal varicella vaccination, despite the considerable clinical and economic burden of varicella disease. Methods An existing dynamic transmission model of varicella infection was calibrated to age-specific seroprevalence rates in Norway. Six two-dose vaccination strategies were considered, consisting of combinations of two formulations each of a monovalent varicella vaccine (Varivax® or Varilrix®) and a quadrivalent vaccine against measles-mumps-rubella-varicella (ProQuad® or PriorixTetra®), with the first dose given with a monovalent vaccine at age 15 months, and the second dose with either a monovalent or quadrivalent vaccine at either 18 months, 7 or 11 years. Costs were considered from the perspectives of both the health care system and society. Quality-adjusted life-years saved and incremental cost-effectiveness ratios relative to no vaccination were calculated. A one-way sensitivity analysis was conducted to assess the impact of vaccine efficacy, price, the costs of a lost workday and of inpatient and outpatient care, vaccination coverage, and discount rate. Results In the absence of varicella vaccination, the annual incidence of natural varicella is estimated to be 1,359 per 100,000 population, and the cumulative numbers of varicella outpatient cases, hospitalizations, and deaths over 50 years are projected to be 1.81 million, 10,161, and 61, respectively. Universal varicella vaccination is projected to reduce the natural varicella incidence rate to 48–59 per 100,000 population, depending on the vaccination strategy, and to reduce varicella outpatient cases, hospitalizations, and deaths by 75–85%, 67–79%, and 75–79%, respectively. All strategies were cost-saving, with the most cost-saving as two doses of Varivax® at 15 months and 7 years (payer perspective) and two doses of Varivax® at 15 months and 18 months (societal perspective). Conclusions All modeled two-dose varicella vaccination strategies are projected to lead to substantial reductions in varicella disease and to be cost saving compared to no vaccination in Norway.

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Measles CEA

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.153 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S64-S65

Author(s):

Emily Hyle

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Economic Value ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

International Travel ◽

Sensitivity Analyses ◽

Base Case ◽

Cost Effectiveness Ratio ◽

The Impact

Abstract Background Most measles importations are due to returning US travelers infected during international travel. We projected clinical outcomes and assessed cost-effectiveness of pretravel evaluation for measles immunity and MMR vaccination among eligible adult US international travelers. Methods We designed a decision tree to investigate pretravel evaluation compared with no evaluation from the societal perspective. Data from the Global TravEpiNet Consortium and published literature informed input parameters (Figure 1). Outcomes included measles cases averted per 10 million travelers, costs, and the incremental cost-effectiveness ratio (ICER, Δcosts/Δmeasles cases averted); we considered ICERs < $100,000/measles case averted to be cost-effective. We performed sensitivity analyses to assess the impact of varying the probability of exposure based on travel destination, and the percentage of travelers with pre-existing measles immunity. Results In the base case, departure after pretravel evaluation resulted in 16 measles importations and 46 transmissions per 10 million travelers and cost $132 million, vs without pretravel evaluation (26 importations and 87 transmissions per 10 million travelers, costing $22 million). Pretravel evaluation averted 51 measles cases per 10 million travelers with an ICER of $2.2 million per case averted. Results were most sensitive to the probability of measles exposure and the traveler’s pre-existing immunity (Figure 2). Pretravel evaluation was cost-effective for travelers to Asia if pre-existing measles immunity was <80%. Evaluation was always cost-effective for travelers to Africa when pre-existing immunity was less than 100% and became cost saving when the percentage of immune travelers was lower (<70%). Travelers who were more likely to be non-immune and were visiting destinations with higher probabilities of exposure were most likely to benefit from pretravel evaluation for measles immunity at excellent economic value. Conclusion As risk of measles exposure increases and likelihood of travelers’ pre-existing immunity decreases, it can be cost-effective or cost saving to assess US international travelers’ measles immunity status and vaccinate with MMR prior to departure. Disclosures All authors: No reported disclosures.

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Clinical Impact, Costs, and Cost-Effectiveness of Expanded SARS-CoV-2 Testing in Massachusetts

10.1101/2020.07.23.20160820 ◽

2020 ◽

Author(s):

Anne M Neilan ◽

Elena Losina ◽

Audrey C. Bangs ◽

Clare Flanagan ◽

Christopher Panella ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Published Data ◽

Self Assessment ◽

Testing Strategies ◽

Incidence And Mortality ◽

Sensitivity Specificity ◽

Hospital Days

Background We projected the clinical and economic impact of alternative testing strategies on COVID-19 incidence and mortality in Massachusetts using a microsimulation model. Methods We compared five testing strategies: 1) PCR-severe-only: PCR testing only patients with severe/critical symptoms; 2) Self-screen: PCR-severe-only plus self-assessment of COVID-19-consistent symptoms with self-isolation if positive; 3) PCR-any-symptom: PCR for any COVID-19-consistent symptoms with self-isolation if positive; 4) PCR-all: PCR-any-symptom and one-time PCR for the entire population; and, 5) PCR-all-repeat: PCR-all with monthly re-testing. We examined effective reproduction numbers (Re, 0.9-2.0) at which policy conclusions would change. We used published data on disease progression and mortality, transmission, PCR sensitivity/specificity (70/100%) and costs. Model-projected outcomes included infections, deaths, tests performed, hospital-days, and costs over 180-days, as well as incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year [QALY]). Results In all scenarios, PCR-all-repeat would lead to the best clinical outcomes and PCR-severe-only would lead to the worst; at Re 0.9, PCR-all-repeat vs. PCR-severe-only resulted in a 63% reduction in infections and a 44% reduction in deaths, but required >65-fold more tests/day with 4-fold higher costs. PCR-all-repeat had an ICER <$100,000/QALY only when Re≥1.8. At all Re values, PCR-any-symptom was cost-saving compared to other strategies. Conclusions Testing people with any COVID-19-consistent symptoms would be cost-saving compared to restricting testing to only those with symptoms severe enough to warrant hospital care. Expanding PCR testing to asymptomatic people would decrease infections, deaths, and hospitalizations. Universal screening would be cost-effective when paired with monthly retesting in settings where the COVID-19 pandemic is surging.

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Abstract 1: Impact of Predicted Bleeding Risk on the Cost-Effectiveness of Direct Thrombin Inhibition vs. Heparin Monotherapy for Patients Undergoing PCI

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.a1 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Amit P Amin ◽

Steven P Marso ◽

Sunil V Rao ◽

John Messenger ◽

John House ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Major Bleeding ◽

Cost Effective ◽

Bleeding Risk ◽

Thrombin Inhibitors ◽

Published Data ◽

Life Years ◽

The Cost ◽

Predicted Risk

Introduction Direct thrombin inhibitors (DTI) reduce bleeding and are cost-saving in patients (pts) undergoing PCI when compared to unfractionated heparin (UFH) plus routine glycoprotein IIb/IIIa inhibition (GPI). Little is known about the cost-effectiveness of DTI alone vs. UFH alone, however. Methods We combined data on patient-level bleeding risk with several external data sources to estimate the economic impact of substituting DTI for UFH among unselected PCI patients. We used a validated model to predict the risk of major bleeding for 81,628 NCDR® CathPCI Registry® patients who received UFH only in 2004-06. DTI costs were estimated based on current FDA dosing guidelines and acquisition costs. The cost of major bleeding ($8722) was estimated based on data from the Mid America Heart Institute. The benefit of DTI vs. UFH alone was based on bleeding risk reduction from ISAR-REACT 3. A Markov model based on published data was used to estimate the loss in life expectancy associated with major bleeding. Results The overall rate of major bleeding in the reference population was 2.2%, the estimated cost of a major bleed was $8722, projected DTI costs were $641/pt and heparin costs were negligible ($4). Assuming that DTI use reduces the risk of bleeding by 33%, use of DTI for all patients was estimated to increase costs by $573/patient and was cost saving only for patients with a predicted risk of major bleeding >20% (0.16% of the overall population). When life years lost due to bleeding were included, at willingness-to-pay thresholds of $50K and $100K per life year gained, DTI was cost effective for patients with a bleeding risk ≥8% (2.5% patients) and ≥5% (7.9% of patients), respectively. Conclusions For patients undergoing PCI, substitution of DTI for UFH monotherapy is projected to increase costs for virtually all patients, but may be reasonably cost-effective for patients with a high predicted risk (≥5%) of bleeding.

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Intervention Packages to Reduce the Impact of HIV and HCV Infections Among People Who Inject Drugs in Eastern Europe and Central Asia: A Modeling and Cost-effectiveness Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy040 ◽

2018 ◽

Vol 5 (3) ◽

Cited By ~ 8

Author(s):

Guillaume Mabileau ◽

Otilia Scutelniciuc ◽

Maia Tsereteli ◽

Ivan Konorazov ◽

Alla Yelizaryeva ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Eastern Europe ◽

Central Asia ◽

People Who Inject Drugs ◽

Cost Effective ◽

High Impact ◽

Hiv Diagnosis ◽

Republic Of Moldova ◽

The Impact

Abstract Background We evaluated the effectiveness and cost-effectiveness of interventions targeting hepatitis C virus (HCV) and HIV infections among people who inject drugs (PWID) in Eastern Europe/Central Asia. We specifically considered the needle-syringe program (NSP), opioid substitution therapy (OST), HCV and HIV diagnosis, antiretroviral therapy (ART), and/or new HCV treatment (direct acting antiviral [DAA]) in Belarus, Georgia, Kazakhstan, Republic of Moldova, and Tajikistan. Methods We developed a deterministic dynamic compartmental model and evaluated the number of infections averted, costs, and incremental cost-effectiveness ratios (ICERs) of interventions. OST decreased frequencies of injecting by 85% and NSP needle sharing rates by 57%; ART was introduced at CD4 <350 and DAA at fibrosis stage ≥F2 at a $2370 to $23 280 cost. Results Increasing NSP+OST had a high impact on transmissions (infections averted in PWID: 42% in Tajikistan to 55% in Republic of Moldova for HCV; 30% in Belarus to 61% in Kazakhstan for HIV over 20 years). Increasing NSP+OST+ART was very cost-effective in Georgia (ICER = $910/year of life saved [YLS]), and was cost-saving in Kazakhstan and Republic of Moldova. NSP+OST+ART and HIV diagnosis was very cost-effective in Tajikistan (ICER = $210/YLS). Increasing the coverage of all interventions was always the most effective strategy and was cost-effective in Belarus and Kazakhstan (ICER = $12 960 and $21 850/YLS); it became cost-effective/cost-saving in all countries when we decreased DAA costs. Conclusion Increasing NSP+OST coverage, in addition to ART and HIV diagnosis, had a high impact on both epidemics and was very cost-effective and even cost-saving. When HCV diagnosis was improved, increased DAA averted a high number of new infections if associated with NSP+OST.

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Cost-effectiveness of on-site musculoskeletal ultrasound in an outpatient rheumatology clinic

Rheumatology ◽

10.1093/rheumatology/keaa678 ◽

2020 ◽

Author(s):

Carlos Acebes ◽

Laura Rubio ◽

Almudena Román ◽

Antonio Herrero ◽

Javier Arcos

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Electronic Medical Records ◽

Medical Records ◽

Cost Effective ◽

Musculoskeletal Ultrasound ◽

X Rays ◽

Rheumatology Clinic ◽

The Impact ◽

Direct Discharge

Abstract Objective To evaluate the impact of the routine use of musculoskeletal ultrasound (MSUS) in rheumatology clinics by comparing one clinic with on-site MSUS (REU 1) and four clinics without this resource, which need to refer patients for the MSUS exams (REU 2–5). Methods The electronic medical records of all new patients at five rheumatology clinics during a 12-month period were reviewed. The impact of MSUS was analysed by comparing the percentage of direct discharges of patients from the different clinics, as an outcome of effectiveness, and the number and cost of radiology referrals for imaging exams (MSUS and MRI), as an outcome of cost-saving. Results The medical records of 4923 patients were included in the study, distributed as follows: REU 1, 1464 (29.7%); REU 2, 1042 (21.2%); REU 3, 1089 (22.1%); REU 4, 579 (11.8%); and REU 5, 749 (15.2%). There were more direct discharges from REU 1 (34.4%) than from REU 2–5 (15.6%) (P<0.001). REU 1 made radiological referrals for X-rays, MRIs or MSUS exams in 773 (52.8%) patients, compared with 2626 (75.9%) patients in REU 2–5 (P<0.001). An estimation of costs for the clinical assessment of 1000 new patients revealed a cost-saving in REU 1 of €21 413 in MSUS and of €877 in MRI exams. Conclusion The implementation of on-site MSUS in a new-patient rheumatology clinic is cost-effective, facilitating the direct discharge of patients and reducing the number and cost of radiological referrals for imaging exams.

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Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet?

10.1101/065540 ◽

2016 ◽

Author(s):

Moira Verbelen ◽

Michael E Weale ◽

Cathryn M Lewis

Keyword(s):

Genetic Testing ◽

Cost Effectiveness ◽

Cost Saving ◽

Genetic Information ◽

Cost Effective ◽

Economic Evaluations ◽

Treatment Needs ◽

The Us ◽

The Cost ◽

The Impact

AbstractPharmacogenetics (PGx) has the potential to personalize pharmaceutical treatments. Many relevant gene-drug associations have been discovered, but PGx guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard healthcare. Progress in this area can be assessed by reviewing economic evaluations to determine the cost-effectiveness of PGx testing versus standard treatment. We performed a review of economic evaluations for PGx associations listed in the US Food and Drug Administration (FDA) Table of Pharmacogenomic Biomarkers in Drug Labeling (http://www.fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/ucm083378.htm). We determined the proportion of evaluations that found PGx guided treatment to be cost-effective or dominant over the alternative strategies, and we estimated the impact on this proportion of removing the cost of genetic testing. Of the 130 PGx associations in the FDA table, 44 economic evaluations, relating to 10 drugs, were identified. Of these evaluations, 57% drew conclusions in favour of PGx testing, of which 30% were cost-effective and 27% were dominant (cost-saving). If genetic information was freely available, 75% of economic evaluations would support PGx guided treatment, of which 25% would be cost-effective and 50% would be dominant. Thus, PGx guided treatment can be a cost-effective and even cost-saving strategy. Having genetic information readily available in the clinical health record is a realistic future prospect, and would make more genetic tests economically worthwhile. However, few drugs with PGx associations have been studied and more economic evaluations are needed to underpin the uptake of genetic testing in clinical practice.

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Conflicting findings between the Mitra-Fr and the Coapt trials: Implications regarding the cost-effectiveness of percutaneous repair for heart failure patients with severe secondary mitral regurgitation

PLoS ONE ◽

10.1371/journal.pone.0241361 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241361

Author(s):

Xavier Armoiry ◽

Jean-François Obadia ◽

Peter Auguste ◽

Martin Connock

Keyword(s):

Heart Failure ◽

Cost Effectiveness ◽

Mitral Regurgitation ◽

Cost Effective ◽

Base Case ◽

Published Data ◽

Parametric Modelling ◽

Percutaneous Repair ◽

The Cost ◽

The Impact

Purpose Two randomized controlled trials (RCTs), Mitra-Fr and Coapt, evaluating the benefit of percutaneous repair (PR) for heart failure (HF) patients with severe mitral regurgitation, have led to conflicting results. We aimed to evaluate the impact of these trial results on the cost-effectiveness of PR using effectiveness inputs from the two RCTs. Methods We developed a time varying Markov type model with three mutually exclusive health states: alive without HF hospitalisation, alive with HF hospitalisation, and dead. Clinically plausible extrapolations beyond observed data were obtained by developing parametric modelling for overall survival and HF hospitalisations using published data from each trial. We adopted the perspective of the French Health System and used a 30-year time horizon. Results were expressed as € / quality-adjusted life year (QALY) gained using utility inputs from literature. Findings Results are presented using treatment efficacy measures from Mitra-F and Coapt trials respectively. With the Mitra-Fr data, after annual discounting, the base case model generated an incremental 0.00387 QALY at a cost of €25,010, yielding an incremental cost effectiveness ratio (ICER) of €6,467,032 / QALY. The model was sensitive to changes made to model inputs. There was no potential of PR being cost-effective. With the Coapt data, the model generated 1.19 QALY gain at a cost of €26,130 yielding an ICER of €21,918 / QALY and at a threshold of >€50,000/QALY PR had a probability of 1 of being cost-effective. Implications Cost effectiveness results were conflicting; reconciling differences between trials is a priority and could promote optimal cost effectiveness analyses and resource allocation.

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Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change

Heart ◽

10.1136/heartjnl-2017-311749 ◽

2017 ◽

Vol 104 (5) ◽

pp. 416-422 ◽

Cited By ~ 5

Author(s):

Simon Claridge ◽

Frederic A Sebag ◽

Steven Fearn ◽

Jonathan M Behar ◽

Bradley Porter ◽

...

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Cost Effective ◽

Cardiac Resynchronisation Therapy ◽

Mortality Data ◽

Published Data ◽

Life Years ◽

Cardiac Resynchronisation ◽

Resynchronisation Therapy ◽

The Impact

ObjectiveResponders to cardiac resynchronisation therapy whose device has a defibrillator component and who do not receive a therapy in the lifetime of the first generator have a very low incidence of appropriate therapy after box change. We investigated the cost implications of using a risk stratification tool at the time of generator change resulting in these patients being reimplanted with a resynchronisation pacemaker.MethodsA decision tree was created using previously published data which had demonstrated an annualised appropriate defibrillator therapy risk of 2.33%. Costs were calculated at National Health Service (NHS) national tariff rates (2016–2017). EQ-5D utility values were applied to device reimplantations, admissions and mortality data, which were then used to estimate quality-adjusted life-years (QALYs) over 5 years.ResultsAt 5 years, the incremental cost of replacing a resynchronisation defibrillator device with a second resynchronisation defibrillator versus resynchronisation pacemaker was £5045 per patient. Incremental QALY gained was 0.0165 (defibrillator vs pacemaker), resulting in an incremental cost-effectiveness ratio (ICER) of £305 712 per QALYs gained. Probabilistic sensitivity analysis resulted in an ICER of £313 612 (defibrillator vs pacemaker). For reimplantation of all patients with a defibrillator rather than a pacemaker to yield an ICER of less than £30 000 per QALY gained (current NHS cut-off for approval of treatment), the annual arrhythmic event rate would need to be 9.3%. The budget impact of selective replacement was a saving of £2 133 985 per year.ConclusionsImplanting low-risk patients with a resynchronisation defibrillator with the same device at the time of generator change is not cost-effective by current NHS criteria. Further research is required to understand the impact of these findings on individual patients at the time of generator change.

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