Life expectancy gains and cost-effectiveness of implantable cardioverter/defibrillators for the primary prevention of sudden cardiac death in patients with hypertrophic cardiomyopathy.
BACKGROUND
Sudden cardiac death (SCD) is a devastating complication of hypertrophic cardiomyopathy (HCM). The optimal strategy for the primary prevention of SCD in HCM remains controversial.


METHODS
Using a Markov model, we compared the health benefits and cost-effectiveness of 3 strategies for the primary prevention of SCD: implantable cardioverter/defibrillator (ICD) insertion, amiodarone therapy, or no therapy. We modeled hypothetical cohorts of 45-year-old patients with HCM with no history of cardiac arrest but at significant risk of SCD (3%/y).


RESULTS
Over a lifetime, compared with no therapy, ICD therapy increased quality-adjusted survival by 4.7 quality-adjusted life years (QALYs) at an additional cost of $142,800 ($30,000 per QALY), whereas amiodarone increased quality-adjusted survival by 2.8 QALYs at an additional cost of $104,900 ($37,300 per QALY). Compared with no therapy, ICD therapy would cost < $50,000 per QALY for patients (i) aged 25, with > or = 1 risk factors for SCD, and (ii) aged 45 or 65, with > or = 2 risk factors for SCD.


CONCLUSIONS
An ICD strategy is projected to yield the greatest increase in quality-adjusted life expectancy of the 3 treatment strategies evaluated. Combined consideration of age and the number of risk factors for SCD may allow more precise tailoring of ICD therapy to its expected benefits.
You
John J
JJ
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. john.you@ices.on.ca
Woo
Anna
A
Ko
Dennis T
DT
Cameron
Douglas A
DA
Mihailovic
Alexandra
A
Krahn
Murray
M
D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000191:economics / Q000401:mortality* / Q000628:therapy; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics*; D004554:Electric Countershock / Q000191:economics / Q000295:instrumentation*; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008390:Markov Chains; D008875:Middle Aged; D011322:Primary Prevention / Q000191:economics*; D011788:Quality of Life; D015996:Survival Rate