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Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).

Publication ,  Journal Article
Mark, DB; Nelson, CL; Anstrom, KJ; Al-Khatib, SM; Tsiatis, AA; Cowper, PA; Clapp-Channing, NE; Davidson-Ray, L; Poole, JE; Johnson, G; Lee, KL ...
Published in: Circulation
July 11, 2006

BACKGROUND: In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), implantable cardioverter-defibrillator (ICD) therapy significantly reduced all-cause mortality rates compared with medical therapy alone in patients with stable, moderately symptomatic heart failure, whereas amiodarone had no benefit on mortality rates. We examined long-term economic implications of these results. METHODS AND RESULTS: Medical costs were estimated by using hospital billing data and the Medicare Fee Schedule. Our base case cost-effectiveness analysis used empirical clinical and cost data to estimate the lifetime incremental cost of saving an extra life-year with ICD therapy relative to medical therapy alone. At 5 years, the amiodarone arm had a survival rate equivalent to that of the placebo arm and higher costs than the placebo arm. For ICD relative to medical therapy alone, the base case lifetime cost-effectiveness and cost-utility ratios (discounted at 3%) were dollar 38,389 per life-year saved (LYS) and dollar 41,530 per quality-adjusted LYS, respectively. A cost-effectiveness ratio < dollar 100,000 was obtained in 99% of 1000 bootstrap repetitions. The cost-effectiveness ratio was sensitive to the amount of extrapolation beyond the empirical 5-year trial data: dollar 127,503 per LYS at 5 years, dollar 88,657 per LYS at 8 years, and dollar 58,510 per LYS at 12 years. Because of a significant interaction between ICD treatment and New York Heart Association class, the cost-effectiveness ratio was dollar 29,872 per LYS for class II, whereas there was incremental cost but no incremental benefit in class III. CONCLUSIONS: Prophylactic use of single-lead, shock-only ICD therapy is economically attractive in patients with stable, moderately symptomatic heart failure with an ejection fraction < or = 35%, particularly those in NYHA class II, as long as the benefits of ICD therapy observed in the SCD-HeFT persist for at least 8 years.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 11, 2006

Volume

114

Issue

2

Start / End Page

135 / 142

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Medical Records
  • Humans
  • Heart Failure
  • Equipment Design
  • Electroshock
  • Defibrillators, Implantable
 

Citation

APA
Chicago
ICMJE
MLA
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Mark, D. B., Nelson, C. L., Anstrom, K. J., Al-Khatib, S. M., Tsiatis, A. A., Cowper, P. A., … SCD-HeFT Investigators. (2006). Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation, 114(2), 135–142. https://doi.org/10.1161/CIRCULATIONAHA.105.581884
Mark, Daniel B., Charlotte L. Nelson, Kevin J. Anstrom, Sana M. Al-Khatib, Anastasios A. Tsiatis, Patricia A. Cowper, Nancy E. Clapp-Channing, et al. “Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).Circulation 114, no. 2 (July 11, 2006): 135–42. https://doi.org/10.1161/CIRCULATIONAHA.105.581884.
Mark DB, Nelson CL, Anstrom KJ, Al-Khatib SM, Tsiatis AA, Cowper PA, et al. Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation. 2006 Jul 11;114(2):135–42.
Mark, Daniel B., et al. “Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).Circulation, vol. 114, no. 2, July 2006, pp. 135–42. Pubmed, doi:10.1161/CIRCULATIONAHA.105.581884.
Mark DB, Nelson CL, Anstrom KJ, Al-Khatib SM, Tsiatis AA, Cowper PA, Clapp-Channing NE, Davidson-Ray L, Poole JE, Johnson G, Anderson J, Lee KL, Bardy GH, SCD-HeFT Investigators. Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation. 2006 Jul 11;114(2):135–142.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 11, 2006

Volume

114

Issue

2

Start / End Page

135 / 142

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Medical Records
  • Humans
  • Heart Failure
  • Equipment Design
  • Electroshock
  • Defibrillators, Implantable