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lüll Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population Cowie MR; Marshall D; Drummond M; Ferko N; Maschio M; Ekman M; de Roy L; Heidbuchel H; Verboven Y; Braunschweig F; Linde C; Boriani GEuropace 2009[Jun]; 11 (6): 716-26AIMS: Current European guidelines recommend prophylactic implantation of cardioverter defibrillators (ICDs) in patients with a reduced left ventricular ejection fraction (LVEF) who are not in NYHA class IV and have reasonable life expectancy. Cost and benefit implications of this recommendation have not been reported from a European perspective. METHODS AND RESULTS: Markov modelling estimated lifetime costs and effects [life years (LY) and quality-adjusted LY (QALY) gained] of prophylactic ICD implantation vs. conventional treatment, among patients with a reduced LVEF. Efficacy was estimated from a meta-analysis of mortality rates in the six primary prevention trials with inclusion criteria matching ACC/AHA/ESC Class I or IIa recommendations. Direct medical costs were estimated using Belgian national references. Costs and effects were discounted at 3 and 1.5% per annum, respectively. Probabilistic sensitivity and scenario analyses estimated the uncertainty around the incremental cost-effectiveness ratio. An ICD implantation increased the lifetime direct costs by euro 46,413. Estimated mean LY/QALY gained were 1.88/1.57, respectively. Probabilistic analysis estimated mean lifetime cost per QALY gained as euro 31,717 (95% CI: euro 19,760-euro 61,316). Cost-effectiveness was influenced most by ICD efficacy, time to replacement, utility, and patient age at implantation. CONCLUSION: In a European healthcare setting, prophylactic ICD implantation may be cost-effective if current guidelines for patients with a reduced LVEF are followed.|*Models, Economic[MESH]|Cost of Illness[MESH]|Cost-Benefit Analysis[MESH]|Death, Sudden, Cardiac/*epidemiology/*prevention & control[MESH]|Defibrillators, Implantable/*economics[MESH]|Europe/epidemiology[MESH]|Female[MESH]|Humans[MESH]|Life Expectancy[MESH]|Male[MESH]|Markov Chains[MESH]|Middle Aged[MESH]|Models, Cardiovascular[MESH]|Risk Assessment[MESH]|Risk Factors[MESH]|Survival Analysis[MESH]|Survival Rate[MESH]|Treatment Outcome[MESH]|Ventricular Dysfunction, Left/*economics/mortality/*prevention & control[MESH] |