title: Cost-effectiveness of implantable defibrillators after myocardial infarction based on 8-year follow-up data (MADIT II).
abstract: OBJECTIVE
  About 190,000 Germans experience a myocardial infarction each year. Of these, 25% may be eligible for an implantable cardioverter defibrillator (ICD) due to low left ventricular ejection fraction. Given the high costs of implantation, the purpose of this study was to assess the cost-effectiveness of ICDs compared to conventional therapy in patients with an ejection fraction 30% or less after MI in Germany.
  
  
  METHODS
  The economic evaluation was performed from the perspective of the German statutory health insurance. To simulate costs and effectiveness over lifetime, a Markov model was constructed with seven health states. The model was based on 8-year follow-up data for ICD implantation after myocardial infarction (MADIT II), which was published recently.
  
  
  RESULTS
  The analysis shows that ICD implantation compared to conventional therapy in patients fulfilling MADIT-II criteria has a cost-effectiveness ratio of €44,736 per quality-adjusted life year gained. If every patient insured by the statutory health insurance and fulfilling the MADIT-II criteria would receive an ICD, the model suggests expenditures between €173 million and €1.7 billion per year.
  
  
  CONCLUSIONS
  ICD therapy cannot be considered clearly cost-effective when compared to many well-accepted interventions. If policy makers decide to reimburse ICDs in the MADIT-II population, they will need to either raise premiums or abandon coverage for other currently funded medical interventions.
authors.affiliation: Pennington Biomedical Research Center/Louisiana State University, Baton Rouge, LA 70808, USA. afschin.gandjour@pbrc.edu
authors.forename: Afschin
authors.initials: A
authors.lastname: Gandjour
authors.forename: Astrid
authors.initials: A
authors.lastname: Holler
authors.lastname: Dipl-Ges-Ök
authors.forename: Charles Christian
authors.initials: CC
authors.lastname: Adarkwah
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017147:Defibrillators, Implantable / Q000191:economics*; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D018803:Models, Economic; D009203:Myocardial Infarction / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D013997:Time Factors