Cardiac arrest: implantable cardioverter defibrillators were not clearly more effective than amiodarone.

Clinical bottom line (level 1b)

  1. Using implantable cardioverter defibrillators compared with amiodarone in patients at risk for sudden cardiac death was not clearly more cost-effective.
Owens et al: Annals of Internal Medicine 1997; 126: 1-12
Expires October 2004

The study

cost-effectiveness study.
Setting: acute hospitals, USA.

Markov decision model of patients with a previous cardiac arrest at high risk for sudden cardiac death comparing amiodarone, implantable cardioverter defibrillators or amiodarone followed by defibrillator if an arrhythmia occurred on amiodarone. Data obtained from randomised controlled trials (no information on selection or appraisal).

  • Viewpoint: society.
  • Benefit assessment: death, neurological impairment.
  • Resources and costs: direct medical costs (including therapy, laboratory tests, hospitalisation, cost of defibrillator replacement every 4 years). Costs were discounted at 3% per year.
  • Sensitivity analysis: adjusting for effectiveness of therapies, quality of life.

    • The evidence

    intervention cost
    ICD $88400
    ( expenditure per year of life saved compared with amiodarone: $54000 )
    amiodarone to ICD $54600
    ( expenditure per year of life saved compared with amiodarone: $89600 )
    amiodarone only $51000

    Effect of sensitivity analysis: Assumptions about the length of time between replacing defibrillators, treatment effectiveness and the quality of life affect the choice of therapy. Unless an ICD is 30% or more effective than amiodarone, it costs more than $50000 per quality-adjusted life-year saved.

    Citation

    1. Owens DK, Sanders GD, Harris RA, et al: cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death. Annals of Internal Medicine 1997; 126: 1-12
    Contributor: Chris Ball and Musab Hayatli, October 1999
    Reviewer: William Rhoton

    Clinical Question.
    Patient at risk for sudden cardiac death.
    Intervention or Exposure implantable cardioverter defibrillator.
    Comparison amiodarone
    Outcome cost-effectiveness.