{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T14:48:25Z","timestamp":1772722105888,"version":"3.50.1"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T00:00:00Z","timestamp":1605744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medtronic"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Implantable cardiac defibrillators (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) are well-established but underutilized globally. The Improve SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP) based on PP patients with the presence of certain risk factors. We evaluated the cost-effectiveness of ICD therapy compared to no ICD among the PP population and the subset of 1.5PP patients in Taiwan.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A Markov model was run over a lifetime time horizon from the Taiwan payer perspective. Mortality and utility estimates were obtained from the literature (PP) and the IMPROVE SCA trial (1.5PP). Cost inputs were obtained from the Taiwan National Health Insurance Administration (NHIA), Ministry of Health and Welfare. We used a willingness-to-pay (WTP) threshold of NT$2,100,000, as established through standard WTP research methods and in alignment with World Health Organization recommendations.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The total discounted costs for ICD therapy and no ICD therapy were NT$1,664,259 and NT$646,396 respectively for PP, while they were NT$2,410,603 and NT$905,881 respectively for 1.5PP. Total discounted QALYs for ICD therapy and no ICD therapy were 6.48 and 4.98 respectively for PP, while they were 10.78 and 7.71 respectively for 1.5PP. The incremental cost effectiveness ratio was NT$708,711 for PP and NT$441,153 for 1.5PP, therefore ICD therapy should be considered cost effective for PP and highly cost effective for 1.5PP.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>ICD therapy compared to no ICD therapy is cost-effective in the whole PP population and highly cost-effective in the subset 1.5PP population in Taiwan.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0241697","type":"journal-article","created":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T18:27:27Z","timestamp":1605810447000},"page":"e0241697","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Implantable cardioverter defibrillator therapy is cost effective for primary prevention patients in Taiwan: An analysis from the Improve SCA trial"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8995-3024","authenticated-orcid":true,"given":"Reece","family":"Holbrook","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas","family":"Higuera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kael","family":"Wherry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dave","family":"Phay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Cheng","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuo-Hung","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0623-9146","authenticated-orcid":true,"given":"Yen-Bin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,11,19]]},"reference":[{"issue":"3","key":"pone.0241697.ref001","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1056\/NEJMoa043399","article-title":"Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure","volume":"352","author":"GH Bardy","year":"2005","journal-title":"N Engl J Med"},{"issue":"12","key":"pone.0241697.ref002","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1056\/NEJMoa013474","article-title":"Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction","volume":"346","author":"AJ Moss","year":"2002","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0241697.ref003","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1001\/jama.2012.157182","article-title":"Survival of patients receiving a primary prevention implantable cardioverter-defibrillator in clinical practice vs clinical trials","volume":"309","author":"SM Al-Khatib","year":"2013","journal-title":"JAMA"},{"issue":"19","key":"pone.0241697.ref004","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1161\/CIRCULATIONAHA.119.043012","article-title":"Association Between Use of Primary-Prevention Implantable Cardioverter-Defibrillators and Mortality in Patients With Heart Failure: A Prospective Propensity Score-Matched Analysis From the Swedish Heart Failure Registry","volume":"140","author":"B Schrage","year":"2019","journal-title":"Circulation"},{"issue":"41","key":"pone.0241697.ref005","doi-asserted-by":"crossref","first-page":"2793","DOI":"10.1093\/eurheartj\/ehv316","article-title":"2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)","volume":"36","author":"SG Priori","year":"2015","journal-title":"Eur Heart J"},{"issue":"21","key":"pone.0241697.ref006","first-page":"e350","article-title":"ACC\/AHA\/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC\/AHA\/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons","volume":"117","author":"AE Epstein","year":"2008","journal-title":"Circulation"},{"issue":"6","key":"pone.0241697.ref007","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1093\/europace\/eup068","article-title":"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","volume":"11","author":"MR Cowie","year":"2009","journal-title":"Europace"},{"issue":"2","key":"pone.0241697.ref008","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1161\/CIRCULATIONAHA.105.581884","article-title":"Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)","volume":"114","author":"DB Mark","year":"2006","journal-title":"Circulation"},{"issue":"11","key":"pone.0241697.ref009","article-title":"Disparity Between Indications for and Utilization of Implantable Cardioverter Defibrillators in Asian Patients With Heart Failure","volume":"10","author":"YMF Chia","year":"2017","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"11","key":"pone.0241697.ref010","first-page":"1720","article-title":"Improve the prevention of sudden cardiac arrest in emerging countries: the Improve SCA clinical study design","volume":"17","author":"S Zhang","year":"2015","journal-title":"Europace"},{"issue":"3","key":"pone.0241697.ref011","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/j.hrthm.2019.09.023","article-title":"Utilization of implantable cardioverter-defibrillators for the prevention of sudden cardiac death in emerging countries: Improve SCA clinical trial","volume":"17","author":"S Zhang","year":"2020","journal-title":"Heart Rhythm"},{"issue":"9","key":"pone.0241697.ref012","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/j.hrthm.2010.07.015","article-title":"Review of the registry's fourth year, incorporating lead data and pediatric ICD procedures, and use as a national performance measure","volume":"7","author":"SC Hammill","year":"2010","journal-title":"Heart Rhythm"},{"issue":"18","key":"pone.0241697.ref013","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1001\/jama.2013.4598","article-title":"Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial","volume":"309","author":"M Gasparini","year":"2013","journal-title":"JAMA"},{"issue":"5","key":"pone.0241697.ref014","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/j.hrthm.2015.01.017","article-title":"Low inappropriate shock rates in patients with single- and dual\/triple-chamber implantable cardioverter-defibrillators using a novel suite of detection algorithms: PainFree SST trial primary results","volume":"12","author":"A Auricchio","year":"2015","journal-title":"Heart Rhythm"},{"issue":"1","key":"pone.0241697.ref015","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/jce.12273","article-title":"Programming implantable cardioverter-defibrillators in patients with primary prevention indication to prolong time to first shock: results from the PROVIDE study","volume":"25","author":"M Saeed","year":"2014","journal-title":"J Cardiovasc Electrophysiol"},{"issue":"24","key":"pone.0241697.ref016","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1056\/NEJMoa1211107","article-title":"Reduction in inappropriate therapy and mortality through ICD programming","volume":"367","author":"AJ Moss","year":"2012","journal-title":"N Engl J Med"},{"issue":"10","key":"pone.0241697.ref017","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/S0002-9149(98)00090-3","article-title":"Causes and consequences of discontinuation of the implantable cardioverter-defibrillator therapy in non-terminally ill patients","volume":"81","author":"H Li","year":"1998","journal-title":"Am J Cardiol"},{"issue":"6","key":"pone.0241697.ref018","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/s12471-014-0556-6","article-title":"Incidence of lead dislodgement, malfunction and perforation during the first year following device implantation","volume":"22","author":"A Ghani","year":"2014","journal-title":"Neth Heart J"},{"issue":"11","key":"pone.0241697.ref019","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.115.002418","article-title":"Transvenous Implantable Cardioverter-Defibrillator (ICD) Lead Performance: A Meta-Analysis of Observational Studies","volume":"4","author":"R Providencia","year":"2015","journal-title":"J Am Heart Assoc"},{"issue":"16","key":"pone.0241697.ref020","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1161\/CIRCULATIONAHA.110.976076","article-title":"Complication rates associated with pacemaker or implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry","volume":"122","author":"JE Poole","year":"2010","journal-title":"Circulation"},{"key":"pone.0241697.ref021","first-page":"1","article-title":"Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer","volume":"2020","author":"EL Eby","journal-title":"J Med Econ"},{"issue":"4","key":"pone.0241697.ref022","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.jacep.2016.01.019","article-title":"Microbiology of Cardiac Implantable Electronic Device Infections","volume":"2","author":"AA Hussein","year":"2016","journal-title":"JACC Clin Electrophysiol"},{"key":"pone.0241697.ref023","unstructured":"National Health Insurance Administration Ministry of Health and Welfare Taipei 10634, Taiwan National Health Insurance Administration; 2015 [cited 2019 9 September 2019]. Available from: https:\/\/www.nhi.gov.tw\/Content_List.aspx?n=150B11D4DCAB0FFD&topgdrtn=5FE8C9FEAE863B46."},{"key":"pone.0241697.ref024","unstructured":"Taiwan Ministry of Health and Welfare [cited 2019 October 21]. Available from: https:\/\/www.nhi.gov.tw\/Content_List.aspx?n=150B11D4DCAB0FFD&topgdrtn=5FE8C9FEAE863B46."},{"key":"pone.0241697.ref025","unstructured":"National Health Insurance Administration Ministry of Health and Welfare [Internet]. National Health Insurance Administration. 2019 [cited 19 September 2019]. Available from: https:\/\/www.nhi.gov.tw\/Content_List.aspx?n=58ED9C8D8417D00B&topn=5FE8C9FEAE863B46."},{"key":"pone.0241697.ref026","unstructured":"Central Bank of the Republic of China (Taiwan) [Internet]. 2019 [cited 01 December 2017]. Available from: http:\/\/www.cbc.gov.tw\/lp.asp?CtNode=695&CtUnit=303&BaseDSD=32&mp=2."},{"key":"pone.0241697.ref027","article-title":"Utilization of implantable cardioverter-defibrillators for the prevention of sudden cardiac death in emerging countries: Improve SCA clinical trial","author":"S Zhang","year":"2019","journal-title":"Heart Rhythm"},{"issue":"5","key":"pone.0241697.ref028","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.hrthm.2017.12.026","article-title":"Defibrillator shocks and their effect on objective and subjective patient outcomes: Results of the PainFree SST clinical trial","volume":"15","author":"SF Sears","year":"2018","journal-title":"Heart Rhythm"},{"issue":"11","key":"pone.0241697.ref029","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/j.jfma.2012.12.015","article-title":"Estimating quality weights for EQ-5D (EuroQol-5 dimensions) health states with the time trade-off method in Taiwan","volume":"112","author":"HY Lee","year":"2013","journal-title":"J Formos Med Assoc"},{"issue":"6","key":"pone.0241697.ref030","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1093\/europace\/euz018","article-title":"The impact of implantable cardioverter-defibrillator implantation on health-related quality of life in the DANISH trial","volume":"21","author":"JS Bundgaard","year":"2019","journal-title":"Europace"},{"issue":"14","key":"pone.0241697.ref031","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1056\/NEJMsa051989","article-title":"Cost-effectiveness of implantable cardioverter-defibrillators","volume":"353","author":"GD Sanders","year":"2005","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0241697.ref032","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1002\/hec.1481","article-title":"International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?","volume":"19","author":"T Shiroiwa","year":"2010","journal-title":"Health Econ"},{"issue":"1","key":"pone.0241697.ref033","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/pace.12238","article-title":"Cost-effectiveness of primary prevention implantable cardioverter defibrillator treatment: data from a large clinical registry","volume":"37","author":"J Thijssen","year":"2014","journal-title":"Pacing Clin Electrophysiol"},{"issue":"2","key":"pone.0241697.ref034","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1253\/circj.CJ-14-0925","article-title":"Current status of primary prevention of sudden cardiac death with implantable cardioverter defibrillator in patients with chronic heart failure\u2014a report from the CHART-2 Study","volume":"79","author":"H Satake","year":"2015","journal-title":"Circ J"},{"issue":"9","key":"pone.0241697.ref035","doi-asserted-by":"crossref","first-page":"841","DOI":"10.4070\/kcj.2018.0444","article-title":"Temporal Trends of Cardiac Implantable Electronic Device Implantations: a Nationwide Population-based Study","volume":"49","author":"JH Lee","year":"2019","journal-title":"Korean Circ J"},{"key":"pone.0241697.ref036","unstructured":"Taiwan Ministry of Health and Welfare Available from: https:\/\/www.nhi.gov.tw\/Content_List.aspx?n=150B11D4DCAB0FFD&topgdrtn=5FE8C9FEAE863B46."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241697","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T18:28:28Z","timestamp":1605810508000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241697"}},"subtitle":[],"editor":[{"given":"Andrea","family":"Ballotta","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,19]]},"references-count":36,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,19]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0241697","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,19]]}}}