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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
Cost-effectiveness of implanted defibrillators in young people with inherited cardiac arrhythmias
Ilan Goldenberg1, Arthur J Moss, Barry J Maron
1Department of Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA. Ilan.Goldenberg@heart.rochester.edu
Insights
Implanted cardioverter-defibrillator (ICD) therapy is cost-effective for high-risk patients with inherited cardiac disorders like long QT syndrome and hypertrophic cardiomyopathy. This life-saving device improves survival and offers economic benefits by preventing sudden cardiac death.
Area of Science:
- Cardiology
- Medical Economics
- Genetics
Background:
- Implanted cardioverter-defibrillators (ICDs) improve survival in adults with acquired heart disease.
- Limited data exist on ICD cost-effectiveness in inherited cardiac disorders.
Purpose of the Study:
- To evaluate the cost-effectiveness of ICD therapy versus non-ICD therapy.
- To analyze ICD benefits in patients with long QT syndrome (LQTS) and hypertrophic cardiomyopathy (HCM).
Main Methods:
- Developed two computer-based analytical models for LQTS and HCM patients.
- Stratified patients into low-risk, high-risk (primary prevention), and very high-risk (secondary prevention) groups.
- Calculated net costs and cost per quality-adjusted life-years (QALYs) saved.
Main Results:
- ICD therapy was cost-effective/saving for high-risk and very high-risk LQTS and HCM patients.
- ICD therapy was not cost-effective for low-risk patients (ICER: $400,000-$600,000 lost per QALY).
- Sensitivity analyses confirmed these findings across risk groups.
Conclusions:
- Early ICD intervention is cost-effective to cost-saving in selected inherited cardiac disorder patients.
- ICD therapy provides economic benefits through increased productivity from prevented sudden cardiac death.
Background:
The implanted cardioverter-defibrillator (ICD) has been shown to improve survival in adult patients with high risk acquired cardiac disease, with a cost-effectiveness ratio in the range of $30,000 to $185,000 per quality-adjusted-life-year saved. However, data on the benefit and cost-effectiveness of device therapy in high-risk patients with inherited cardiac disorders are limited.
Methods:
We developed two separate computer-based analytical models to compare non-ICD with ICD therapy in patients (age range: 10-75 years) with long QT syndrome (LQTS) and hypertrophic cardiomyopathy (HCM). In each disease entity patients were stratified into low-risk (no known risk factors); high-risk (known risk factors [primary prevention]); and very high-risk (prior near-fatal events [secondary prevention]). Net costs were defined as the difference between costs resulting from treatment of the disease and savings due to gained productivity attributable to prevention of sudden cardiac death. Outcome was defined as costs per quality-adjusted life-years saved.
Results:
In LQTS, defibrillator therapy was shown to be cost effective in high-risk male patients (incremental cost-effectiveness ratio [ICER]=$3328 per quality-adjusted-life-year saved), and cost saving in high-risk females (ICER=$7102 gained per quality-adjusted-life-year saved) and very high-risk males and females (ICER=$15,483 and 19,393 gained per quality-adjusted-life-year saved, respectively). In HCM, defibrillator therapy was cost saving in both male and female high-risk (ICER=$17,892 and $17,526 gained per quality-adjusted-life-year saved, respectively) and very high-risk (ICER $22,944 and $22,329 gained per quality-adjusted-life-year saved, respectively) patients. Defibrillator therapy was not shown to be cost effective in low-risk patients with either LQTS or HCM (ICER in the range of $400,000 to $600,000 lost per quality-adjusted-life-year saved). Sensitivity analyses were consistent with the results in each risk group.
Conclusions:
In appropriately selected patients with inherited cardiac disorders, early intervention with ICD therapy is cost-effective to cost saving due to added years of gained productivity when the lifespan of an individual at risk is considered.
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