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Wearable cardioverter-defibrillators in pediatric cardiomyopathy: A cost-utility analysis

Patrick D Evers1, Jeffrey B Anderson2, Thomas D Ryan2

  • 1Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Heart Rhythm
|September 3, 2019
PubMed

Insights

For children with dilated cardiomyopathy (DCM), using a wearable cardioverter-defibrillator (WCD) at home during medical optimization is a cost-effective strategy to prevent sudden cardiac arrest (SCA) before implantable cardioverter-defibrillator (ICD) placement.

Area of Science:

  • Pediatric Cardiology
  • Medical Device Technology
  • Health Economics

Background:

  • Dilated cardiomyopathy (DCM) is the most common pediatric heart condition.
  • Severe cardiac dysfunction in DCM increases the risk of sudden cardiac arrest (SCA).
  • Wearable cardioverter-defibrillators (WCDs) offer outpatient arrhythmia protection during medical optimization before permanent implantable cardioverter-defibrillator (ICD) implantation.

Purpose of the Study:

  • To identify the most cost-effective strategy for managing pediatric DCM patients during medical optimization.
  • To compare the cost, survival, and quality-of-life outcomes of different clinical approaches before ICD placement.

Main Methods:

  • A Markov state transition model was used to analyze three strategies: Inpatient, Home-WCD, and Home-No WCD.
  • Data on transitional probabilities, costs, and quality-of-life metrics were sourced from existing literature.
  • Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER) against a $50,000 per quality-adjusted life year threshold.

Main Results:

  • The Home-WCD strategy achieved an ICER of $20,103 per quality-adjusted life year, preventing 4 mortalities per 100 patients compared to Home-No WCD.
  • Home-No WCD became more cost-effective only under specific low-risk scenarios for SCA or high survival rates with WCDs.

Conclusions:

  • Utilizing a wearable cardioverter-defibrillator (WCD) at home during medical optimization is a potentially cost-effective approach for pediatric DCM patients.
  • This strategy may improve survival rates and reduce healthcare costs for high-risk pediatric patients awaiting ICD implantation.
Abstract

Keywords:
ArrhythmiaCost-utilityDilated cardiomyopathyPediatricsWearable cardioverter-defibrillators

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