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Automatic implantable cardioverter-defibrillator: is early implantation cost-effective?
S O'Donoghue1, E V Platia, S Brooks-Robinson
1Cardiac Arrhythmia Center, Washington Hospital Center, Washington, D.C.
Insights
Early implantation of cardioverter-defibrillators for sudden cardiac death survivors is cost-effective. This approach avoids lengthy hospitalizations associated with serial electrophysiologic studies and drug trials.
Area of Science:
- Cardiology
- Medical Device Technology
Background:
- Sudden cardiac death (SCD) survivors often require extensive evaluation.
- Serial electrophysiologic studies and drug trials lead to prolonged, costly hospitalizations.
- Automatic implantable cardioverter-defibrillators (AICDs) are crucial for managing SCD risk.
Purpose of the Study:
- To compare the cost-effectiveness of early AICD implantation versus conventional serial electrophysiologic testing.
- To evaluate hospitalization duration and cost for different management strategies in SCD survivors.
Main Methods:
- Retrospective comparison of two groups of SCD survivors.
- Group 1: Underwent serial electrophysiologic studies and drug trials (n=32).
- Group 2: Underwent direct AICD implantation after initial electrophysiologic study (n=7).
Main Results:
- Conventional approach: 20.2 days hospitalization, $48,900 cost.
- Early AICD implantation: 12.6 days hospitalization, $40,400 cost.
- Early AICD implantation was associated with shorter hospital stays and lower costs.
Conclusions:
- Early AICD implantation is not more costly than conventional serial testing for SCD survivors.
- Direct AICD implantation may be a more cost-effective strategy.
- Advancements in AICD technology may further favor earlier implantation.
Abstract:
The evaluation of survivors of sudden cardiac death with serial electrophysiologic studies involves a lengthy and expensive hospitalization, especially when an automatic implantable cardioverter-defibrillator is ultimately necessary. The cost efficacy of this conventional approach was therefore compared with direct implantation of a cardioverter-defibrillator after the first electrophysiologic study. Thirty-two survivors of sudden death who had inducible ventricular tachycardia during their initial electrophysiologic study underwent serial drug trials. At discharge 12 (37%) were taking an antiarrhythmic drug found to prevent induction of ventricular tachycardia and 20 underwent cardioverter-defibrillator implantation after serial drug trials proved ineffective. The average length of hospitalization for this group that had undergone serial drug testing was 20.2 +/- 9.3 days at an average cost of $48,900 +/- $31,600. Seven survivors of sudden death had no inducible ventricular tachycardia during their initial electrophysiologic study and underwent direct cardioverter-defibrillator implantation. Their average length of hospitalization was 12.6 +/- 6.2 days at an average cost of $40,400 +/- $8,300. It is concluded that automatic implantable cardioverter-defibrillator implantation as an early intervention is not more costly and indeed may be cost-effective compared with therapy guided by serial electrophysiologic testing. As antitachycardia devices become more versatile, long lived and easier to implant, earlier implantation is likely to compare even more favorably with drug therapy.