Economic outcomes of implantable cardioverter-defibrillators.
BACKGROUND
We reviewed the literature pertaining to the cost-effectiveness of implantable cardioverter-defibrillator (ICD) therapy in the management of ventricular fibrillation and tachycardia. Discussed are the methodology, advantages, and limitations of economic-outcomes analyses as related to ICD therapy; the impact of new technology and physician practice patterns; and methodological recommendations for future studies.


RESULTS
Articles published between 1990 and 1997 were screened for cost-effectiveness analyses of ICD versus antiarrhythmic drug therapy. Randomized clinical trials, prospective and retrospective studies, and economic models were included. These studies report incremental cost-effectiveness ratios ranging from cost savings of $13 975 per life-year saved (LYS) to an incremental cost of $114 917 per LYS for ICD therapy. Differences were due to study type, cost-reporting methodology, ICD technology used, and length of follow-up. Assuming current technology and physician practice patterns, we find that ICD total therapy costs may break even in 1 to 3 years.


CONCLUSIONS
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.
Stanton
M S
MS
Medtronic Inc, Minneapolis, Minn, and Charles River Associates Inc, Boston, MA, USA. marshall.stanton@medtronic.com
Bell
G K
GK
D002309:Cardiology / Q000639:trends; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D016032:Randomized Controlled Trials as Topic