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Are implantable cardioverter- defibrillators cost-effective?
1Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 5342, Los Angeles, CA 90048, USA. c.peter@cshs.org
Insights
Implantable cardioverter-defibrillators (ICDs) offer survival benefits for sudden cardiac death survivors. The cost-effectiveness of ICDs compared to antiarrhythmic drugs is considered acceptable given the survival advantage.
Area of Science:
- Cardiology
- Medical Technology
- Health Economics
Background:
- Sudden cardiac death (SCD) is a major cause of cardiovascular mortality.
- Ventricular tachyarrhythmias are frequently implicated in SCD.
- Implantable cardioverter-defibrillators (ICDs) have demonstrated survival benefits in specific patient groups.
Purpose of the Study:
- To evaluate the cost-effectiveness of ICDs compared to antiarrhythmic drug therapy.
- To assess the incremental cost per life-year saved by ICDs in high-risk patients.
Main Methods:
- Analysis of data from randomized controlled trials comparing ICDs and antiarrhythmic drugs.
- Economic evaluation focusing on incremental costs and life-years gained.
Main Results:
- In patients with nonsustained ventricular tachycardia, low ejection fraction, and inducible sustained ventricular tachycardia unresponsive to procainamide, ICDs cost $27,000 per life-year saved compared to drug therapy.
- This cost is considered acceptable given the survival benefits.
Conclusions:
- ICD therapy provides a significant survival advantage in selected patients at risk for sudden cardiac death.
- The incremental cost of ICDs is a potentially acceptable investment for improving patient survival.
- Future technological advancements may further enhance the cost-effectiveness of ICDs.
Abstract:
Sudden cardiac deaths account for a large number of cardiovascular deaths, and ventricular tachyarrhythmias are implicated in many of these. In survivors of sudden cardiac deaths and other selected groups of patients, implantable cardioverter-defibrillators (ICDs) have been shown to have significant survival benefits in randomized controlled trials. The incremental costs for each extra year of survival conferred by ICDs were compared to the cost of antiarrhythmic drug therapy in some of these trials. In patients with nonsustained ventricular tachycardia with low ejection fraction (< 35%) and inducible sustained ventricular tachycardia on programmed electrical stimulation (nonsuppressible by procainamide), the incremental costs of ICD therapy amounted to $27,000 per life-year saved, compared with drug therapy. These costs may be acceptable increments for adaptation of the new technology in view of the definite survival advantage conferred by ICDs. Evolving technology may further reduce these costs by development of better devices with longer battery life.