Ventricular arrhythmia: implantable cardioverter-defibrillators were not cost-effective

Clinical bottom line (level 1b)

  1. Implantable cardioverter-defibrillators were not cost-effective for reducing death in survivors of previous episodes of VT or VF
O'Brien et al: Circulation 2001; 103 : 1416-1421
Expires May 2004

The study

Cost-effectiveness study
Setting: university hospital, Canada

randomised controlled trial comparing implantable cardioverter-defibrillators with amiodarone for survivors of episodes of ventricular fibrillation or tachycardia

  • Viewpoint: government healthcare payer (HMO or NHS equivalent)
  • Benefit assessment: gain in life expectancy:
  • Resources and costs: ICD implantation, length of hospital stay, cardiac surgical procedures, major diagnostic procedures, outpatient physician review. Costs were calculated in 1999 Canadiam dollars using the Ontario Case Costing Project, plus physicians' fees and study drugs.
  • Sensitivity analysis: Costs and treatment effectiveness were adjusted. Long-term effects of ICDs are unknown, so three survival curves were used to determine long term benefits (up to 12 years).

    The evidence

    intervention cost
    cost per life-year gained $213543

    Effect of sensitivity analysis: Cost per life-year gained ranged from $88187 to favoring amiodarone. ICD was more cost-effective in patients with LV dysfunction (ejection fraction < 35%): cost per life-year: $108484

    Citation

    1. O'Brien BJ, Connolly SJ, Goeree R, et al: cost-effectiveness of the implantable cardioverter-defibrillator: results from the Canadian implantable defibrillator study (CIDS). Circulation 2001; 103 : 1416-1421
    Search Terms: from ACP Journal Club
    Contributor: Chris Ball, May 2002
    Reviewer:

    Clinical Question.
    Patient survivor of VT or VF episode
    Intervention or Exposure implantable cardioverter-defibrillator (ICD)
    Outcome cost per life-year gained
    		•