# Cost-effectiveness analysis of an implantable cardiac defibrillator compared with pharmaceutical therapy in patients hospitalized with arrhythmia in Iran

## TL;DR

This study compares the cost-effectiveness of implantable cardiac defibrillators and drug therapy for arrhythmia in Iran, finding that defibrillators are not cost-effective.

## Contribution

The study provides a novel cost-effectiveness analysis of ICDs versus pharmaceutical therapy for arrhythmia in the Iranian healthcare context.

## Key findings

- ICD strategy had higher lifetime costs ($41,135) compared to pharmaceutical therapy ($8,592).
- ICER of ICD was $24,286 per QALY, exceeding the WTP threshold of $13,002.
- Probabilistic analysis showed only 40% probability of ICD being cost-effective at the WTP threshold.

## Abstract

Arrhythmia is a type of cardiovascular disorder that can be fatal. Several methods for treating cardiac arrhythmia have been developed, the most significant of which are implantable cardiac defibrillator (ICD) placement and pharmaceutical therapy. The present study aimed to analyze the cost-effectiveness of an ICD strategy compared to the pharmaceutical therapy in patients with arrhythmia in Iran.This is an economic evaluation study that was carried out using the Markov model for lifetime time horizon. The study population includes all patients with cardiac arrhythmia hospitalized in Shafa hospital in Kerman, eastern-south of Iran, between 2017 and 2019. The study sample includes 101 patients who were treated using the ICD method and 101 randomly selected patients who were received pharmaceutical treatment. This study is conducted from the perspective of the health system, and only direct costs (medical and non-medical) are derived. The study’s outcome was defined as the quality-adjusted life-year (QALY). The data was analyzed using TreeAge software version 2020, and the incremental cost-effectiveness ratio (ICER) was compared to a willingness-to-pay (WTP) threshold of three times GDP per capita in 2021 ($13,002). Deterministic and probabilistic sensitivity analyses were performed to examine the effect of uncertain model parameters on cost effectiveness anlysis. The results revealed that the lifetime costs of ICD and pharmaceutical therapy strategies in treating cardiac arrhythmia were $41,135 and $8,592, respectively, with outcomes equal to 12.63 and 11.29 QALYs. The ICER of the ICD strategy compared to the pharmaceutical therapy was $24,286 per QALY, and it was not cost-effective. The probabilistic sensitivity analysis demonstrated that at a WTP of three times the GDP per capita, the ICD approach had a 40% cost-effectiveness probability. According to the findings of this study, the ICD strategy, when compared to pharmaceutical therapy, is not cost-effective for the treatment of patients with cardiac arrhythmia in Iran. Resource allocation and cost-cutting measures must be implemented as needed.