Cost-effectiveness analysis of invasive and noninvasive tests in high risk patients treated with amiodarone after acute myocardial infarction.
OBJECTIVE
We sought to evaluate 1) the cost-effectiveness of amiodarone therapy in postinfarction patients; and 2) the influence of alternative diagnostic strategies (noninvasive only vs. noninvasive and electrophysiologic testing) on survival benefit and cost-effectiveness ratio of amiodarone therapy.


BACKGROUND
The cost-effectiveness of amiodarone therapy in postinfarction patients is still unknown, and no study has determined which diagnostic strategy should be used to maximize amiodarone survival benefit while improving its cost-effectiveness ratio.


METHODS
We designed a postinfarction scenario wherein heart rate variability analysis on 24-h Holter monitoring was used as a screening test for 2-year amiodarone therapy in a cohort of survivors (mean age 57 years) of a recent myocardial infarction. Three different therapeutic strategies were compared: 1) no amiodarone; 2) amiodarone in patients with depressed heart rate variability; 3) amiodarone in patients with depressed heart rate variability and a positive programmed ventricular stimulation. Total variable costs and quality-adjusted life expectancy during a 20-year period were predicted with use of a Markov simulation model. Costs and charges were calculated with reference to an Italian and American hospital.


RESULTS
Amiodarone therapy in patients with depressed heart rate variability and a positive programmed ventricular stimulation was dominated by a blend of the two alternatives. Compared with the no-treatment strategy, the incremental cost-effectiveness ratio of amiodarone therapy in patients with depressed heart rate variability was $10,633 and $39,422 per gained quality-adjusted life-year using Italian costs and American charges, respectively.


CONCLUSIONS
Compared with a noninterventional option, amiodarone prescription in all patients with depressed heart rate variability seems to be a more appropriate approach than the alternative based on the combined use of heart rate variability and electrophysiologic study.
Pedretti
R F
RF
Fondazione Salvatore Maugeri, Care and Research Institute, Administrative Department, Rehabilitation Institute, Tradate, Italy. tradate@fsm.it
Migliori
G B
GB
Mapelli
V
V
Daniele
G
G
Podrid
P J
PJ
Tramarin
R
R
D000638:Amiodarone / Q000191:economics* / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D015716:Electrocardiography, Ambulatory; D006334:Heart Function Tests / Q000191:economics; D006801:Humans; D007558:Italy; D008390:Markov Chains; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone