Automatic implantable cardioverter defibrillator: cost effectiveness

Unexpected out-of-hospital cardiac arrest is in most cases due to ventricular fibrillation or rapid ventricular tachycardia. The usual therapeutic strategy in survivors starts with drug treatment, in case of failure followed by nonpharmacological therapy, which may include catheter ablation, ablative surgery, and finally defibrillator implantation. In most cases, this strategy is long lasting and very expensive. Implantation of a defibrillator as a first choice therapy may be cost effective, especially if the probability of successful drug treatment is low. However, cost-effective aspects have been studied only retrospectively and in models. In 1989 we started a prospective cost-effectiveness analysis of implantation of the automatic implantable cardioverter defibrillator (AICD) as first choice therapy ("early" AICD implantation) in successfully resuscitated postinfarct patients. Evaluation is being done in a randomized way with one group having early AICD implantation and the other group following the usual conventional therapeutic strategy. We compare medical, economic, and quality-of-life aspects. As of June 1992, 46 patients have entered the study. Totally 60 patients will be included. Results are expected in 1993 and will be expressed as cost effectiveness ratios in both study arms.