Potential impact of antiarrhythmic drugs versus implantable defibrillators on the management of ventricular arrhythmias: the Midlands trial of empirical amiodarone versus electrophysiologically guided intervention and cardioverter implant registry data

Pathmanathan, R; Lau, Ernest W.; Cooper, J.; Newton, Laura; Skehan, J D; Garratt, Clifford J.; Griffith, Mike

doi:10.1136/hrt.80.1.68

Cited by 9 publications

(4 citation statements)

References 5 publications

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“…The Midlands Trial of Empirical Amiodarone Versus Electrophysiologically Guided Intervention and Cardioverter Implant in Ventricular Arrhythmias (MAVERIC) registry [15] (data from United Kingdom) is a population-based trial designed on the AVID study. Its aim is to determine the number of patients who satisfy the AVID criteria, Future Trends in Implantable CardioverterDefibrillator Therapy…”

Section: Midlands Trial Of Empirical Amiodarone Versus Electrophysiolmentioning

confidence: 99%

Are implantable cardioverter-defibrillators cost-effective?

Naik

2000

Curr Cardiol Rep

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Sudden cardiac deaths account for a large number of cardiovascular deaths, and ventricular tachyarrhythmias are implicated in many of these. In survivors of sudden cardiac deaths and other selected groups of patients, implantable cardioverter-defibrillators (ICDs) have been shown to have significant survival benefits in randomized controlled trials. The incremental costs for each extra year of survival conferred by ICDs were compared to the cost of antiarrhythmic drug therapy in some of these trials. In patients with nonsustained ventricular tachycardia with low ejection fraction (< 35%) and inducible sustained ventricular tachycardia on programmed electrical stimulation (nonsuppressible by procainamide), the incremental costs of ICD therapy amounted to $27,000 per life-year saved, compared with drug therapy. These costs may be acceptable increments for adaptation of the new technology in view of the definite survival advantage conferred by ICDs. Evolving technology may further reduce these costs by development of better devices with longer battery life.

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Section: Midlands Trial Of Empirical Amiodarone Versus Electrophysiolmentioning

confidence: 99%

Are implantable cardioverter-defibrillators cost-effective?

Naik

2000

Curr Cardiol Rep

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“…However, indirect evidence suggests that even in the US the actual rate of implantation is lower than projections based on current guidelines [14]. Strict application of the definitive AVID criteria for ICD implantation in the field of secondary prevention of sudden death would probably lead (in the UK at least) to an escalation of implants and related costs [15]. Despite recent price reductions, the problem of cost remains a major determinant for full acceptance and application of ICD therapy.…”

Section: Evidence Supporting Icd Prophylaxismentioning

confidence: 99%

Cardioverter‐defibrillators after MADIT‐II: the balance between weight of evidence and treatment costs

Boriani

Biffi

Martignani

et al. 2003

European J of Heart Fail

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The possibility of using implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death in selected highrisk patients has prompted a series of prospective controlled studies. Recently, the MADIT II study highlighted the possibility of effective primary prevention of sudden death in patients with coronary artery disease selected by straightforward clinical data and without expensive screening (electrophysiological study). For patients with previous myocardial infarction and low left ventricular ejection fraction ((30%), ICD implantation may reduce mortality risk by approximately 31% in the following 2 years. Implementation of this therapeutic strategy threatens to impact on public health-care spending. Possible cost-limiting mechanisms include price cuts because of increasing usage (market forces); identification of subgroups at higher risk of sudden death and use of cheaper devices with limited diagnostic and therapeutic options. Further long-term evaluation of the cost-effectiveness and cost-utility of ICDs should identify subgroups of patients for whom implantation is affordable despite current economic constraints. For heart failure patients, randomized controlled trials are currently evaluating the effects on overall survival of both conventional ICDs and devices with biventricular pacing capabilities. In this perspective, data from the COMPANION trial are expected to stimulate the use of devices with defibrillation back-up in candidates for biventricular pacing.

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“…The application of AVID criteria to a population of British patients with sustained ventricular arrhythmia was evaluated in the Midland trial 27 . These data showed that application of AVID criteria in this area would lead to an increase in ICD implantation from 5 to at least 18 per million inhabitants.…”

Section: Possible Reasons For Delayed Acceptance Of Icd Implantsmentioning

confidence: 99%

Geographic Differences in Implantable Cardioverter Defibrillator Usage

Seidl¹,

Senges²

2002

Cardiovasc electrophysiol

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Geographic Differences in ICD Usage. Despite the demonstrated efficacy of implantable cardioverter defibrillators (ICDs) in reducing sudden and total mortality in selected patients, their implantation rates vary greatly among countries. In the United States, the implantation rate is 185 implants per million inhabitants compared with only 31 implants per million in western Europe. The differences in ICD use may be explained by the following factors: manner in which sudden cardiac death is perceived by politicians and physicians (sudden cardiac death is perceived as a “nice way of dying”); differences in indications; physicians' information; prevalence of coronary artery disease; sudden cardiac death survival rates; perceived reliability of alternative treatment (namely, antiarrhythmics including amiodarone); economic backgrounds; and health care politics. Furthermore, the cost of this treatment strategy must be considered. This issue has been raised because generalization of ICD use in patients matching clinical characteristics of patients enrolled in the primary prevention trials may represent a significant economic burden to be added to the already overloaded health care system. This low acceptance may not be entirely related to budget constraint but also to the perceived efficacy of ICDs by physicians and health authorities.

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Potential impact of antiarrhythmic drugs versus implantable defibrillators on the management of ventricular arrhythmias: the Midlands trial of empirical amiodarone versus electrophysiologically guided intervention and cardioverter implant registry data

Abstract: (Heart 1998;80:68-70)

Cited by 9 publications

References 5 publications

Are implantable cardioverter-defibrillators cost-effective?

Are implantable cardioverter-defibrillators cost-effective?

Cardioverter‐defibrillators after MADIT‐II: the balance between weight of evidence and treatment costs

Geographic Differences in Implantable Cardioverter Defibrillator Usage

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