ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Cost-Effectiveness of Implantable Cardioverter-Defibrillators for Primary Prevention in Heart Failure with Reduced Ejection Fraction: A Markov Model Using JROAD-DPC Cost Data in Japan
Kazuki Ohashi 1
Masaya Watanabe 2,3
Yasuhiro Morii 4
Hisashi Yokoshiki 5
Kengo Kusano 6
Katsuhiko Imai 7
Masahiko Takagi 8
Teiichi Yamane 9
Hirohi Tada 10
Katsuhiko Ogasawara 2,11
1. Hokkaido University, Sapporo, Japan
2. Hokkaido Daigaku, Sapporo, Japan
3. Caress Memorial Hospital, Sapporo, Japan
4. National Institute of Public Health, Wako, Japan
5. Sapporo City General Hospital, Sapporo, Japan
6. Kokuritsu Junkankibyo Kenkyu Center Byoin, Suita, Japan
7. Hiroshima Daigaku, Higashihiroshima, Japan
8. Kansai Ika Daigaku Sogo Iryo Center, Moriguchi, Japan
9. Tokyo Jikeikai Ika Daigaku, Minato, Japan
10. Fukui Daigaku, Fukui, Japan
11. Muroran Kogyo Daigaku, Muroran, Japan
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Abstract
Introduction: Implantable cardioverter defibrillators (ICDs) reduce the risk of sudden cardiac death caused by ventricular tachycardia or fibrillation in patients with ischemic and non-ischemic cardiomyopathies. However, the cost-effectiveness of ICD implantation in Japanese patients with heart failure and reduced left ventricular ejection fraction remains unclear. This study evaluated the cost-effectiveness of ICD implantation in the Japanese settings. Methods: A Markov model with one-month cycles was developed to assess the cost-effectiveness of ICD implantation compared to conventional medical therapy. The analysis was conducted from a public healthcare payer perspective over a 30-year time horizon. Scenario analyses accounting for the waning of treatment effects, as well as deterministic and probabilistic sensitivity analyses (PSA), were performed. Results: In the base-case analysis, the incremental cost-effectiveness ratio (ICER) was US$29,838 per quality-adjusted life year (QALY). In scenario analyses, the ICER increased to US$40,205 per QALY and US$36,199 per QALY when the treatment effect began to wane after 5 and 10 years, respectively. ICD efficacy and battery longevity had the greatest influence on the ICER. The PSA showed that the ICER per QALY ranged from US$19,472 at the 2.5th percentile to US$83,365 at the 97.5th percentile. Conclusions: In the Japanese healthcare context, ICD implantation for primary prevention was more cost-effective than the reference value. However, depending on several assumptions, the ICER could exceed the reference value. Sensitivity analyses highlighted the significant impact of the hazard ratio and battery longevity on cost-effectiveness. Further research is needed to identify subpopulations with distinctly different cost-effectiveness outcomes.
Summary
Keywords
cost-effectiveness analysis, implantable cardioverter-defibrillator, LeftVentricular Ejection Fraction, Primary Prevention, Sudden cardiac death
Received
12 November 2025
Accepted
06 February 2026
Copyright
© 2026 Ohashi, Watanabe, Morii, Yokoshiki, Kusano, Imai, Takagi, Yamane, Tada and Ogasawara. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Katsuhiko Ogasawara
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