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Cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death.

Publication ,  Journal Article
Owens, DK; Sanders, GD; Harris, RA; McDonald, KM; Heidenreich, PA; Dembitzer, AD; Hlatky, MA
Published in: Ann Intern Med
January 1, 1997

BACKGROUND: Implantable cardioverter defibrillators (ICDs) are remarkably effective in terminating ventricular arrhythmias, but they are expensive and the extent to which they extend life is unknown. The marginal cost-effectiveness of ICDs relative to amiodarone has not been clearly established. OBJECTIVE: To compare the cost-effectiveness of a third-generation implantable ICD with that of empirical amiodarone treatment for preventing sudden cardiac death in patients at high or intermediate risk. DESIGN: A Markov model was used to evaluate health and economic outcomes of patients who received an ICD, amiodarone, or a sequential regimen that reserved ICD for patients who had an arrhythmia during amiodarone treatment. MEASUREMENTS: Life-years gained, quality-adjusted life-years gained, costs, and marginal cost-effectiveness. RESULTS: For the base-case analysis, it was assumed that treatment with an ICD would reduce the total mortality rate by 20% to 40% at 1 year compared with amiodarone and that the ICD generator would be replaced every 4 years. In high-risk patients, if an ICD reduces total mortality by 20%, patients who receive an ICD live for 4.18 quality-adjusted life-years and have a lifetime expenditure of $88,400. Patients receiving amiodarone live for 3.68 quality-adjusted life-years and have a lifetime expenditure of $51,000. Marginal cost-effectiveness of an ICD relative to amiodarone is $74,400 per quality-adjusted life-year saved. If an ICD reduces mortality by 40%, the cost-effectiveness of ICD use is $37,300 per quality-adjusted life-year saved. Both choice of therapy (an ICD or amiodarone) and the cost-effectiveness ratio are sensitive to assumptions about quality of life. CONCLUSIONS: Use of an ICD will cost more than $50,000 per quality-adjusted life-year gained unless it reduces all-cause mortality by 30% or more relative to amiodarone. Current evidence does not definitively support or exclude a benefit of this magnitude, but ongoing randomized trials have sufficient statistical power to do so.

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Published In

Ann Intern Med

DOI

ISSN

0003-4819

Publication Date

January 1, 1997

Volume

126

Issue

1

Start / End Page

1 / 12

Location

United States

Related Subject Headings

  • Risk Factors
  • Quality-Adjusted Life Years
  • Middle Aged
  • Markov Chains
  • Humans
  • General & Internal Medicine
  • Defibrillators, Implantable
  • Decision Trees
  • Death, Sudden, Cardiac
  • Cost-Benefit Analysis
 

Citation

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MLA
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Owens, D. K., Sanders, G. D., Harris, R. A., McDonald, K. M., Heidenreich, P. A., Dembitzer, A. D., & Hlatky, M. A. (1997). Cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death. Ann Intern Med, 126(1), 1–12. https://doi.org/10.7326/0003-4819-126-1-199701010-00001
Owens, D. K., G. D. Sanders, R. A. Harris, K. M. McDonald, P. A. Heidenreich, A. D. Dembitzer, and M. A. Hlatky. “Cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death.Ann Intern Med 126, no. 1 (January 1, 1997): 1–12. https://doi.org/10.7326/0003-4819-126-1-199701010-00001.
Owens DK, Sanders GD, Harris RA, McDonald KM, Heidenreich PA, Dembitzer AD, et al. Cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death. Ann Intern Med. 1997 Jan 1;126(1):1–12.
Owens, D. K., et al. “Cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death.Ann Intern Med, vol. 126, no. 1, Jan. 1997, pp. 1–12. Pubmed, doi:10.7326/0003-4819-126-1-199701010-00001.
Owens DK, Sanders GD, Harris RA, McDonald KM, Heidenreich PA, Dembitzer AD, Hlatky MA. Cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death. Ann Intern Med. 1997 Jan 1;126(1):1–12.

Published In

Ann Intern Med

DOI

ISSN

0003-4819

Publication Date

January 1, 1997

Volume

126

Issue

1

Start / End Page

1 / 12

Location

United States

Related Subject Headings

  • Risk Factors
  • Quality-Adjusted Life Years
  • Middle Aged
  • Markov Chains
  • Humans
  • General & Internal Medicine
  • Defibrillators, Implantable
  • Decision Trees
  • Death, Sudden, Cardiac
  • Cost-Benefit Analysis