Cost-effectiveness of a novel antitachycardia pacing algorithm for the termination of ventricular tachyarrhythmias in the United States

Background Ventricular tachyarrhythmias are potentially life-threatening arrhythmias commonly managed with implantable cardioverter-defibrillators (ICDs). Conventional antitachycardia pacing (ATP) can reduce ICD shocks, but its effectiveness varies. Intrinsic antitachycardia pacing (iATP) is a novel algorithm designed to optimize ventricular tachycardia termination and minimize shocks. Objective The purpose of this study was to evaluate the cost-effectiveness of iATP vs conventional ATP for terminating ventricular tachyarrhythmias in the United States. Methods A Markov simulation model was developed to compare lifetime costs, survival, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of iATP vs conventional ATP in patients with ICDs. Model inputs were derived from published literature, and analyses were performed from the perspective of an integrated US health care system. Sensitivity analyses assessed the robustness of findings. Results Compared with conventional ATP, iATP was associated with additional QALYs (10.51 vs 10.33) and additional lifetime costs ($4014 vs $1673), resulting in a discounted ICER of $13,114 per QALY. The ICER is below the US willingness-to-pay (WTP) threshold ($120,000 per QALY). The finding of cost-effectiveness persisted across all sensitivity analyses. Conclusion iATP was associated with clinical benefits and was determined to be a highly cost-effective strategy for managing ventricular tachyarrhythmias in patients with ICDs. The ICER remains below the willingness-to-pay threshold in both deterministic and probabilistic sensitivity analyses, demonstrating the robustness of the findings.