Implantable cardioverter defibrillators: an excellent case study.
Numerous randomized controlled trials have shown that implantable cardioverter defibrillators (ICDs) reduce mortality from sudden cardiac death. Evidence-based medicine can elucidate the benefits of treatment and inform Medicare policy when applied in a consistent and nonselective manner. The use of cost-effectiveness data to determine Medicare coverage-and therefore access to a therapy-involves many practical challenges. Cost-effectiveness analysis may be more useful as a tool to guide marketplace decision making than as a regulatory mechanism. Medicare coverage does not mandate use of a therapy; it allows the discussion to occur between a patient and his or her doctor.
Stanton
Marshall S
MS
Medtronic Cardiac Rhythm Management, in Minneapolis, Minnesota, USA. marshall.stanton@medtronic.com
D017028:Caregivers; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000191:economics; D003695:Delivery of Health Care / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D006761:Hospitals; D006801:Humans; D019458:Insurance Coverage; D006278:Medicare; D010361:Patients; D014481:United States