Cost-effectiveness of the implantable cardioverter-defibrillator versus antiarrhythmic drugs in survivors of serious ventricular tachyarrhythmias: results of the Antiarrhythmics Versus Implantable Defibrillators (AVID) economic analysis substudy.
BACKGROUND
The implantable cardioverter-defibrillator (ICD) is an effective but expensive device. We used prospectively collected data from a large randomized clinical trial of secondary prevention of life-threatening ventricular arrhythmias to determine the cost-effectiveness of the ICD compared with antiarrhythmic drug (AAD) therapy, largely with amiodarone.


RESULTS
Charges for initial and repeat hospitalizations, emergency room, and day surgery stays and the costs of antiarrhythmic drugs were collected on 1008 patients. Detailed records of all other medical encounters and expenses were collected on a subgroup of 237 patients. Regression models were then created to attribute these expenses to the rest of the patients. Charges were converted to 1997 costs using standard methods. Costs and life years were discounted at 3% per year. Three-year survival data from the Antiarrhythmics Versus Implantable Defibrillators trail were used to calculate the base-case cost-effectiveness (C/E) ratio. Six-year, twenty-year, and lifetime C/E ratios were also estimated. At 3 years, total costs were $71 421 for a patient taking AADs and $85 522 for a patient using an ICD, and the ICD provided a 0.21-year survival benefit over AAD treatment. The base-case C/E ratio was thus $66 677 per year of life saved by the ICD compared with AAD therapy (95% CI, $30 761 to $154 768). Six- and 20-year C/E ratios remained stable between $68 000 and $80 000 per year of life saved.


CONCLUSIONS
The ICD is moderately cost-effective for secondary prevention of life-threatening ventricular arrhythmias, as judged from prospectively collected data in a randomized clinical trial.
Larsen
Greg
G
Cardiology Section, Oregon VA Medical Center, Portland, Ore 97201, USA. greg.larsen@med.va.gov
Hallstrom
Alfred
A
McAnulty
John
J
Pinski
Sergio
S
Olarte
Anna
A
Sullivan
Sean
S
Brodsky
Michael
M
Powell
Judy
J
Marchant
Christy
C
Jennings
Cheryl
C
Akiyama
Toshio
T
D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D016019:Survival Analysis; D017741:Survivors; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D013997:Time Factors
D000889:Anti-Arrhythmia Agents