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Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II.

Publication ,  Journal Article
Al-Khatib, SM; Anstrom, KJ; Eisenstein, EL; Peterson, ED; Jollis, JG; Mark, DB; Li, Y; O'Connor, CM; Shaw, LK; Califf, RM
Published in: Ann Intern Med
April 19, 2005

BACKGROUND: The Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II demonstrated that implantable cardioverter defibrillators (ICDs) save lives when used in patients with a history of myocardial infarction (MI) and an ejection fraction of 0.3 or less. OBJECTIVE: To investigate the cost-effectiveness of implanting ICDs in patients who met MADIT-II eligibility criteria and were enrolled in the Duke Cardiovascular Database between 1 January 1986 and 31 December 2001. DESIGN: Cost-effectiveness analysis. DATA SOURCES: Published literature, databases owned by Duke University Medical Center, and Medicare data. TARGET POPULATION: Adults with a history of MI and an ejection fraction of 0.3 or less. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTIONS: ICD therapy versus conventional medical therapy. OUTCOMES MEASURES: Cost per life-year gained and incremental cost-effectiveness. RESULTS: Compared with conventional medical therapy, ICDs are projected to result in an increase of 1.80 discounted years in life expectancy and an incremental cost-effectiveness ratio of 50,500 dollars per life-year gained. Cost-effectiveness varied dramatically with changes in time horizon: The cost-effectiveness ratio increased to 67,800 dollars per life-year gained, 79,900 dollars per life-year gained, 100,000 dollars per life-year gained, 167,900 dollars per life-year gained, and 367,200 dollars per life-year gained for 15-year, 12-year, 9-year, 6-year, and 3-year time horizons, respectively. Changing the frequency of follow-up visits, complication rates, and battery replacements had less of an effect on the cost-effectiveness ratios than reducing the cost of ICD placement and leads. LIMITATIONS: The study was limited by the completeness of the data, referral bias, difference in medical therapy between the Duke cohort and the MADIT-II cohort, and not addressing potential upgrades to biventricular devices. CONCLUSIONS: The economic expense of defibrillator implantation in all patients who meet MADIT-II eligibility criteria is substantial. However, in the range of survival benefit observed in MADIT-II, ICD therapy for these patients is economically attractive by conventional standards.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

April 19, 2005

Volume

142

Issue

8

Start / End Page

593 / 600

Location

United States

Related Subject Headings

  • Survival Analysis
  • Stroke Volume
  • Sensitivity and Specificity
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Humans
  • General & Internal Medicine
  • Eligibility Determination
  • Defibrillators, Implantable
  • Death, Sudden, Cardiac
 

Citation

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Al-Khatib, S. M., Anstrom, K. J., Eisenstein, E. L., Peterson, E. D., Jollis, J. G., Mark, D. B., … Califf, R. M. (2005). Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II. Ann Intern Med, 142(8), 593–600. https://doi.org/10.7326/0003-4819-142-8-200504190-00007
Al-Khatib, Sana M., Kevin J. Anstrom, Eric L. Eisenstein, Eric D. Peterson, James G. Jollis, Daniel B. Mark, Yun Li, Christopher M. O’Connor, Linda K. Shaw, and Robert M. Califf. “Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II.Ann Intern Med 142, no. 8 (April 19, 2005): 593–600. https://doi.org/10.7326/0003-4819-142-8-200504190-00007.
Al-Khatib SM, Anstrom KJ, Eisenstein EL, Peterson ED, Jollis JG, Mark DB, et al. Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II. Ann Intern Med. 2005 Apr 19;142(8):593–600.
Al-Khatib, Sana M., et al. “Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II.Ann Intern Med, vol. 142, no. 8, Apr. 2005, pp. 593–600. Pubmed, doi:10.7326/0003-4819-142-8-200504190-00007.
Al-Khatib SM, Anstrom KJ, Eisenstein EL, Peterson ED, Jollis JG, Mark DB, Li Y, O’Connor CM, Shaw LK, Califf RM. Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II. Ann Intern Med. 2005 Apr 19;142(8):593–600.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

April 19, 2005

Volume

142

Issue

8

Start / End Page

593 / 600

Location

United States

Related Subject Headings

  • Survival Analysis
  • Stroke Volume
  • Sensitivity and Specificity
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Humans
  • General & Internal Medicine
  • Eligibility Determination
  • Defibrillators, Implantable
  • Death, Sudden, Cardiac