Outcomes and costs of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death among the elderly.
BACKGROUND
The clinical outcomes and costs of implantable cardioverter-defibrillators (ICDs) used for primary prevention of sudden cardiac death in nonexperimental settings are uncertain.


OBJECTIVE
The purpose of this study was to measure the health outcomes and costs among a nationally representative cohort of elderly, primary-prevention ICD recipients.


METHODS
We collected health-care cost and utilization data from all Medicare beneficiaries hospitalized for congestive heart failure (CHF) who had received primary-prevention ICDs between October 2003 and September 2005 as well as propensity-score-matched control Medicare beneficiaries hospitalized for CHF during the same period. A multivariable Cox proportional hazards model was fitted to the cohort, which comprised 7125 ICD recipients and 7125 controls and which was followed through December 2005. Medicare claims in the first year inclusive of the index hospitalization were used to assess differences in health-care costs.


RESULTS
ICD receipt was associated with a significant reduction in mortality (adjusted hazard ratio = 0.62, 95% confidence interval 0.58-0.67). ICD patients had higher median hospital costs in the first 30 days after initial hospitalization (median difference = $41,542, P <.001) and at 1 year (median difference = $41,503, P <.001) as well as higher outpatient and physician costs at 6 months (median difference = $1828, P <.001).


CONCLUSIONS
ICD implantation was associated with reduced mortality in a nonexperimental, elderly, primary-prevention patient population hospitalized for CHF. The additional health-care costs of ICD implantation were substantial but comparable to published cost-effectiveness models that have projected ICDs to be cost-effective.
Groeneveld
Peter W
PW
Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania 19104-6021, USA. peter.groeneveld@va.gov
Farmer
Steven A
SA
Suh
Janice J
JJ
Matta
Mary Anne
MA
Yang
Feifei
F
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D011322:Primary Prevention; D016896:Treatment Outcome