An analysis of the cost effectiveness of the implantable defibrillator.

Kuppermann, Miriam; Br, Luce; McGovern, Brian A.; Podrid, PJ; Bigger, Jr Jt; Ruskin, JN

doi:10.1161/01.cir.81.1.91

Cited by 147 publications

(28 citation statements)

References 22 publications

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“…Nineteen economic evaluations were conducted in the USA, 154,[157][158][159]162,[165][166][167][168][169][170]176,177,[179][180][181][182]184,186 five in Canada, 161,163,171,183,185 149,153,155,[157][158][159][160][162][163][164][165]170,174,[176][177][178][179][180][181][182]185 and cost-effectiveness analysis 63,154,[166][167][168][169][171][172][173]…”

Section: Economic Evaluations Of Implantable Cardiac Defibrillatorsmentioning

confidence: 99%

“…156,161 Most studies used a Markov model 149,153,155,[157][158][159][160][162][163][164][166][167][168]171,174,[176][177][178][179][180][181][182]185 with five studies using a trial-based analysis 169,170,173,183,186 and the remaining studies using a variety of methods. Most studies used a long-term time horizon of > 20 years, 149,[153][154][155][157][158][159][160]162,[164][165][166]168,172,[174][175][176][177][178][179][180][181][182]…”

Section: Economic Evaluations Of Implantable Cardiac Defibrillatorsmentioning

confidence: 99%

“…163,170,171,183,184,186 Fourteen studies were based on a single trial 63,154,156,157,161,164,[169][170][171]173,174,180,183,186 with the MADIT II trial 101 (six studies 154,157,164,171,180,186 ) and the SCD-HeFT trial 105 (four studies 156,161,170,174 ) the most commonly used. Ten studies used more than one trial, through meta-analysis, systematic review or different trial populations, 149,153,155,160,163,172,176,177,181,182 eleven studies used other sources of evidence to model the intervention effect 158,162,[165][166][167][168]175,178,179,…”

Section: Economic Evaluations Of Implantable Cardiac Defibrillatorsmentioning

confidence: 99%

“…159 Almost half of the studies (n = 15) reported that ICDs were cost-effective, 149,[154][155][156]160,161,[166][167][168][169][170]172,175,180,185 with an additional six finding ICDs cost-effective for high-risk groups according to study definitions. 158,165,173,176,177,181 Nine studies did not find ICDs cost-effective 153,157,159,162,163,174,178,183,186 and six studies were unclear whether ICDs were cost effective or not.…”

Section: Economic Evaluations Of Implantable Cardiac Defibrillatorsmentioning

confidence: 99%

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Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation

Colquitt¹,

Mendes²,

Clegg³

et al. 2014

Health Technology Assessment

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BackgroundThis assessment updates and expands on two previous technology assessments that evaluated implantable cardioverter defibrillators (ICDs) for arrhythmias and cardiac resynchronisation therapy (CRT) for heart failure (HF).ObjectivesTo assess the clinical effectiveness and cost-effectiveness of ICDs in addition to optimal pharmacological therapy (OPT) for people at increased risk of sudden cardiac death (SCD) as a result of ventricular arrhythmias despite receiving OPT; to assess CRT with or without a defibrillator (CRT-D or CRT-P) in addition to OPT for people with HF as a result of left ventricular systolic dysfunction (LVSD) and cardiac dyssynchrony despite receiving OPT; and to assess CRT-D in addition to OPT for people with both conditions.Data sourcesElectronic resources including MEDLINE, EMBASE and The Cochrane Library were searched from inception to November 2012. Additional studies were sought from reference lists, clinical experts and manufacturers’ submissions to the National Institute for Health and Care Excellence.Review methodsInclusion criteria were applied by two reviewers independently. Data extraction and quality assessment were undertaken by one reviewer and checked by a second. Data were synthesised through narrative review and meta-analyses. For the three populations above, randomised controlled trials (RCTs) comparing (1) ICD with standard therapy, (2) CRT-P or CRT-D with each other or with OPT and (3) CRT-D with OPT, CRT-P or ICD were eligible. Outcomes included mortality, adverse events and quality of life. A previously developed Markov model was adapted to estimate the cost-effectiveness of OPT, ICDs, CRT-P and CRT-D in the three populations by simulating disease progression calculated at 4-weekly cycles over a lifetime horizon.ResultsA total of 4556 references were identified, of which 26 RCTs were included in the review: 13 compared ICD with medical therapy, four compared CRT-P/CRT-D with OPT and nine compared CRT-D with ICD. ICDs reduced all-cause mortality in people at increased risk of SCD, defined in trials as those with previous ventricular arrhythmias/cardiac arrest, myocardial infarction (MI) > 3 weeks previously, non-ischaemic cardiomyopathy (depending on data included) or ischaemic/non-ischaemic HF and left ventricular ejection fraction ≤ 35%. There was no benefit in people scheduled for coronary artery bypass graft. A reduction in SCD but not all-cause mortality was found in people with recent MI. Incremental cost-effectiveness ratios (ICERs) ranged from £14,231 per quality-adjusted life-year (QALY) to £29,756 per QALY for the scenarios modelled. CRT-P and CRT-D reduced mortality and HF hospitalisations, and improved other outcomes, in people with HF as a result of LVSD and cardiac dyssynchrony when compared with OPT. The rate of SCD was lower with CRT-D than with CRT-P but other outcomes were similar. CRT-P and CRT-D compared with OPT produced ICERs of £27,584 per QALY and £27,899 per QALY respectively. The ICER for CRT-D compared with CRT-P was £28,420 per QALY. In people with both conditions, CRT-D reduced the risk of all-cause mortality and HF hospitalisation, and improved other outcomes, compared with ICDs. Complications were more common with CRT-D. Initial management with OPT alone was most cost-effective (ICER £2824 per QALY compared with ICD) when health-related quality of life was kept constant over time. Costs and QALYs for CRT-D and CRT-P were similar. The ICER for CRT-D compared with ICD was £27,195 per QALY and that for CRT-D compared with OPT was £35,193 per QALY.LimitationsLimitations of the model include the structural assumptions made about disease progression and treatment provision, the extrapolation of trial survival estimates over time and the assumptions made around parameter values when evidence was not available for specific patient groups.ConclusionsIn people at risk of SCD as a result of ventricular arrhythmias and in those with HF as a result of LVSD and cardiac dyssynchrony, the interventions modelled produced ICERs of < £30,000 per QALY gained. In people with both conditions, the ICER for CRT-D compared with ICD, but not CRT-D compared with OPT, was < £30,000 per QALY, and the costs and QALYs for CRT-D and CRT-P were similar. A RCT comparing CRT-D and CRT-P in people with HF as a result of LVSD and cardiac dyssynchrony is required, for both those with and those without an ICD indication. A RCT is also needed into the benefits of ICD in non-ischaemic cardiomyopathy in the absence of dyssynchrony.Study registrationThis study is registered as PROSPERO number CRD42012002062.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Economic Evaluations Of Implantable Cardiac Defibrillatorsmentioning

confidence: 99%

Section: Economic Evaluations Of Implantable Cardiac Defibrillatorsmentioning

confidence: 99%

Section: Economic Evaluations Of Implantable Cardiac Defibrillatorsmentioning

confidence: 99%

Section: Economic Evaluations Of Implantable Cardiac Defibrillatorsmentioning

confidence: 99%

See 2 more Smart Citations

Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation

Colquitt¹,

Mendes²,

Clegg³

et al. 2014

Health Technology Assessment

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“…Current viewpoints range from a health care economic debacle to a highly cost-effective alternative in antiarrhythmic therapy, especially when used early in the patient's clinical course as a primary therapeutic option. [8][9][10] Similarities to other cardiovascular therapeutic dilemmas, such as coronary artery bypass surgery and coronary angioplasty, are readily apparent. It is the purpose of this commentary to focus on the medical issues around this therapy that are in imperative need of study by clinical trials.…”

mentioning

confidence: 96%

Implantable defibrillators for prevention of sudden death. Technology at a medical and economic crossroad.

Saksena¹

1992

Circulation

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Implantable cardioverter-defibrillator therapy is now widely used for the treatment of symptomatic patients with documented or suspected life-threatening VTs. Although sudden death recurrence in ICD recipients is virtually eliminated, the extent of benefit both with respect to cardiac mortality and total survival in this patient population remains to be accurately quantitated, particularly vis-à-vis alternative antiarrhythmic therapies. Advanced device and lead systems can be expected to further improve both patient survival and quality of life after implant. The economic impact of unrestrained proliferation in ICD therapy can be enormous; however, available cost-benefit analyses support judicious use of this therapy with comparable economic impact to other accepted cardiovascular therapies. Such prospective risk stratification becomes economically essential when considering expanding its application to asymptomatic or minimally symptomatic populations at potential risk for future cardiac arrest.

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The Cost of Congenital Heart Disease in Children and Adults

Garson

Allen

Gersony

et al. 1994

Arch Pediatr Adolesc Med

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Objective: To assess the cost of congenital heart disease (CHD) and to assess whether practice pattern or price was more responsible for variation. Research Design and Setting: Data were collected from Charleston, NC; Columbus, Ohio; Detroit, Mich; Houston, Tex; Los Angeles, Calif; and New York, NY. The CHD was first classified as to physiologic characteristics and severity. For each type of CHD, the number of clinic visits, hospitalizations, and years of medication use were estimated. Results: On the basis of actual charges, the "prices" were calculated as follows, in 1992 dollars: for patients from birth to 21 years: benign disease (19% of patients), $3940; acyanotic disease (45%), $49 730; cyanotic disease (36%), $102 084; and average for all CHD categories, $59 877; for patients 22 to 40 years of age (of whom 24% had resolved defects or were dead):

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An analysis of the cost effectiveness of the implantable defibrillator.

Cited by 147 publications

References 22 publications

Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation

Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation

Implantable defibrillators for prevention of sudden death. Technology at a medical and economic crossroad.

The Cost of Congenital Heart Disease in Children and Adults

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