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Effect of risk stratification on cost-effectiveness of the implantable cardioverter defibrillator.

Publication ,  Journal Article
Owens, DK; Sanders, GD; Heidenreich, PA; McDonald, KM; Hlatky, MA
Published in: Am Heart J
September 2002

BACKGROUND: Implantable cardioverter defibrillators (ICDs) effectively prevent sudden cardiac death, but selection of appropriate patients for implantation is complex. We evaluated whether risk stratification based on risk of sudden cardiac death alone was sufficient to predict the effectiveness and cost-effectiveness of the ICD. METHODS: We developed a Markov model to evaluate the cost-effectiveness of ICD implantation compared with empiric amiodarone treatment. The model incorporated mortality rates from sudden and nonsudden cardiac death, noncardiac death and costs for each treatment strategy. We based our model inputs on data from randomized clinical trials, registries, and meta-analyses. We assumed that the ICD reduced total mortality rates by 25%, relative to use of amiodarone. RESULTS: The relationship between cost-effectiveness of the ICD and the total annual cardiac mortality rate is U-shaped; cost-effectiveness becomes unfavorable at both low and high total cardiac mortality rates. If the annual total cardiac mortality rate is 12%, the cost-effectiveness of the ICD varies from $36,000 per quality-adjusted life-year (QALY) gained when the ratio of sudden cardiac death to nonsudden cardiac death is 4 to $116,000 per QALY gained when the ratio is 0.25. CONCLUSIONS: The cost-effectiveness of ICD use relative to amiodarone depends on total cardiac mortality rates as well as the ratio of sudden to nonsudden cardiac death. Studies of candidate diagnostic tests for risk stratification should distinguish patients who die suddenly from those who die nonsuddenly, not just patients who die suddenly from those who live.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2002

Volume

144

Issue

3

Start / End Page

440 / 448

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Tachycardia, Ventricular
  • Registries
  • Quality-Adjusted Life Years
  • Quality of Life
  • Outcome Assessment, Health Care
  • Myocardial Infarction
  • Models, Statistical
  • Markov Chains
  • Humans
 

Citation

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Owens, D. K., Sanders, G. D., Heidenreich, P. A., McDonald, K. M., & Hlatky, M. A. (2002). Effect of risk stratification on cost-effectiveness of the implantable cardioverter defibrillator. Am Heart J, 144(3), 440–448. https://doi.org/10.1067/mhj.2002.125501
Owens, Douglas K., Gillian D. Sanders, Paul A. Heidenreich, Kathryn M. McDonald, and Mark A. Hlatky. “Effect of risk stratification on cost-effectiveness of the implantable cardioverter defibrillator.Am Heart J 144, no. 3 (September 2002): 440–48. https://doi.org/10.1067/mhj.2002.125501.
Owens DK, Sanders GD, Heidenreich PA, McDonald KM, Hlatky MA. Effect of risk stratification on cost-effectiveness of the implantable cardioverter defibrillator. Am Heart J. 2002 Sep;144(3):440–8.
Owens, Douglas K., et al. “Effect of risk stratification on cost-effectiveness of the implantable cardioverter defibrillator.Am Heart J, vol. 144, no. 3, Sept. 2002, pp. 440–48. Pubmed, doi:10.1067/mhj.2002.125501.
Owens DK, Sanders GD, Heidenreich PA, McDonald KM, Hlatky MA. Effect of risk stratification on cost-effectiveness of the implantable cardioverter defibrillator. Am Heart J. 2002 Sep;144(3):440–448.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2002

Volume

144

Issue

3

Start / End Page

440 / 448

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Tachycardia, Ventricular
  • Registries
  • Quality-Adjusted Life Years
  • Quality of Life
  • Outcome Assessment, Health Care
  • Myocardial Infarction
  • Models, Statistical
  • Markov Chains
  • Humans