■用于心脏骤停(SCA)一级预防(PP)的植入式心律转复除颤器(ICD)在发展中国家未得到充分利用。改善SCA研究已经确定了1.5个一级预防(1.5PP)患者的子集,这些患者具有较高的SCA风险和ICD治疗的显着死亡率益处。从中国医疗体系的角度来看,我们评估了ICD治疗的成本效益与不对1.5PP患者进行ICD治疗,以告知临床和政策决定.
■对已发布的马尔可夫模型进行了调整和验证,以模拟疾病的病程并描述1.5PP患者的不同健康状况。病人的特点,死亡率,效用和并发症的估计来自改善SCA研究和其他文献.成本投入来自政府投标价格,中国9家公立医院的医疗服务价格和临床专家调查。对于ICD和无ICD治疗,对整个生命周期内的总医疗费用和质量调整生命年(QALYs)进行建模,并计算增量成本-效果比(ICER).进行了确定性和概率敏感性分析以评估模型参数的不确定性。我们使用中国药物经济学评价指南推荐的支付意愿(WTP)阈值,2022年是中国人均GDP的一到三倍(85,698-257,094元人民币)。
■与没有ICD治疗相比,ICD治疗的增量成本效益比(ICER)为139,652CNY/QALY,这大约是中国人均GDP的1-2倍。ICD治疗具有成本效益的概率为92.1%。敏感性分析的结果支持基本案例的发现。
■ICD治疗与没有ICD治疗相比,对于中国的1.5PP患者来说是具有成本效益的。
UNASSIGNED: Implantable cardioverter defibrillator (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) is underutilized in developing countries. The Improve SCA study has identified
a subset of 1.5 primary prevention (1.5PP) patients with
a higher risk of SCA and
a significant mortality benefit from ICD therapy. From the perspective of
China\'s healthcare system, we evaluated the cost-effectiveness of ICD therapy vs. no ICD therapy among 1.5PP patients with a view to informing clinical and policy decisions.
UNASSIGNED: A published Markov model was adjusted and verified to simulate the course of the disease and describe different health states of 1.5PP patients. The patient characteristics, mortality, utility and complication estimates were obtained from the Improve SCA study and other literature. Cost inputs were sourced from government tender prices, medical service prices and clinical experts\' surveys in 9 Chinese public hospitals. For both ICD and no ICD therapy, the total medical costs and quality-adjusted life-years (QALYs) were modelled over a lifetime horizon and the incremental cost-effectiveness ratio (ICER) was calculated. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. We used the willingness-to-pay (WTP) threshold recommended by China Guidelines for Pharmacoeconomic Evaluations, one to three times
China\'s GDP per capita (CNY85,698-CNY257,094) in 2022 Chinese Yuan.
UNASSIGNED: The incremental cost effectiveness ratio (ICER) of ICD therapy compared to no ICD therapy is 139,652 CNY/QALY, which is about 1-2 times China\'s GDP per capita. The probability that ICD therapy is cost effective was 92.1%. Results from sensitivity analysis supported the findings of the base case.
UNASSIGNED: ICD therapy compared to no ICD therapy is cost-effective for the 1.5PP patients in
China.