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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Potential cost-effectiveness of prophylactic use of the implantable cardioverter defibrillator or amiodarone after
G D Sanders1, M A Hlatky, N R Every
1Center for Primary Care and Outcomes Research, 179 Encina Commons, Stanford University, Stanford, CA 94305-6019, USA. sanders@stanford.edu
Annals of Internal Medicine
|November 20, 2001
Summary
Prophylactic implantable cardioverter defibrillators (ICDs) and amiodarone therapy can be cost-effective for myocardial infarction patients with low ejection fractions. Achieving cost-effectiveness requires ICDs to reduce arrhythmic death by 50% or amiodarone to reduce total death by 7%.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Clinical Trials
Background:
- Implantable cardioverter defibrillators (ICDs) improve survival in patients with ventricular arrhythmias.
- Cost-effectiveness of prophylactic ICD or amiodarone therapy requires determination in myocardial infarction (MI) patients.
Purpose of the Study:
- To determine the necessary efficacy of prophylactic ICD or amiodarone therapy to be cost-effective in MI patients.
- Evaluate the cost-effectiveness of ICDs versus amiodarone compared to no treatment.
Main Methods:
- Markov model-based cost utility analysis.
- Data sourced from the Myocardial Infarction Triage and Intervention registry and literature.
- Analysis focused on patients with prior MI but no sustained ventricular arrhythmia over a lifetime horizon.
Main Results:
- ICDs yielded the highest quality-adjusted life-years (QALYs) and costs; amiodarone offered intermediate outcomes.
- Acceptable cost-effectiveness thresholds (<=$75,000/QALY) required ICDs to reduce arrhythmic death by 50% or amiodarone to reduce total death by 7% in patients with depressed ejection fraction.
- For patients with ejection fractions ≤0.3, amiodarone cost $43,100/QALY, while ICDs cost $71,800/QALY compared to amiodarone.
Conclusions:
- Prophylactic ICD or amiodarone may offer significant clinical benefit at an acceptable cost for MI patients with severely depressed left ventricular function.
- Highlights the importance of clinical trials for ICDs in MI patients with low ejection fractions.
- Cost-effectiveness varies based on ejection fraction levels and treatment modality.
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