Economic Outcomes of Implantable Cardioverter-Defibrillators

Abstract

Recent literature suggests that ICDs are a cost-effective therapy for management of life-threatening ventricular tachyarrhythmias. The advent of new technology and patient management practices should further improve the cost-effectiveness of ICD therapy. Future studies of ICD cost-effectiveness should address the implications of truncated follow-up periods and quality of life.

Cost Effectiveness of Cardiac Resynchronization Therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial

“…Results of the present analysis, based on COM-PANION trial data, are consistent with recent cost- Cost-Effectiveness of the COMPANION Trial effectiveness analyses for other implantable cardioverterdefibrillator clinical trials (21)(22)(23). The ICERs for CRT as estimated in the current study are well within the range of other accepted therapies and compare favorably with other therapies with high up-front costs such as bypass surgery (24,25), catheter ablations (26), and tissue plasminogen activator (27).…”

“…In addition to MLHFQ scores, NYHA data were also recorded at three-month intervals throughout the duration of the trial. A published algorithm maps NYHA functional class to health state utilities (21). Changes in utility values from baseline to month 6 based on the MLHFQ were highly correlated with those derived from NYHA functional class.…”

Primary Prevention of Sudden Death With Implantable Defibrillator Therapy in Patients With Cardiac Disease

“…22 The shorter average duration of follow-up may also have led to an underestimation of cost-effectiveness because much of ICD therapy cost occurs early on. 23 Given the modest benefit of the ICD in AVID, analyses were undertaken to identify groups most likely to benefit. One found that the 61% of patients with EF values Ͻ0.35 had a marked (40%) relative reduction in the risk of death with ICD versus drug therapy, whereas patients with higher values did not significantly benefit.…”

Is prophylaxis the best use of the ICD?

“…We hesitate to compare ICD cost-effectiveness studies, simply as only one -the MADIT cost-effectiveness studywas carried out prospectively and with nearly 100% collection of cost data [20] . Two recent publications have pointed to the problems of using incomplete cost-effectiveness studies, and in particular in 'truncating' the period of follow-up, allowing insufficient time to realize the full (ICD) investment [21,22] . The MADIT study showed that the cost-effectiveness of the ICD was approximately $23 000 per life year saved (for a 4-year life device, implanted transvenously) [20] .…”