Cost-Effectiveness of Defibrillator Therapy or Amiodarone in Chronic Stable Heart Failure
| Autor: | Kevin J. Anstrom, Anastasios A. Tsiatis, Jill Anderson, George Johnson, Daniel B. Mark, Gust H. Bardy, Sana M. Al-Khatib, Patricia A. Cowper, Charlotte L. Nelson, Jeanne E. Poole, Kerry L. Lee, Linda Davidson-Ray, Nancy E. Clapp-Channing |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
medicine.medical_specialty Heart disease Cost effectiveness Cost-Benefit Analysis Amiodarone Sudden death Medical Records Sudden cardiac death Physiology (medical) Internal medicine medicine Humans Survival rate Randomized Controlled Trials as Topic Retrospective Studies Heart Failure Electroshock business.industry Mortality rate Equipment Design medicine.disease United States Defibrillators Implantable Death Sudden Cardiac Treatment Outcome Heart failure Cardiology Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Circulation. 114:135-142 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circulationaha.105.581884 |
| Popis: | Background— In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), implantable cardioverter-defibrillator (ICD) therapy significantly reduced all-cause mortality rates compared with medical therapy alone in patients with stable, moderately symptomatic heart failure, whereas amiodarone had no benefit on mortality rates. We examined long-term economic implications of these results. Methods and Results— Medical costs were estimated by using hospital billing data and the Medicare Fee Schedule. Our base case cost-effectiveness analysis used empirical clinical and cost data to estimate the lifetime incremental cost of saving an extra life-year with ICD therapy relative to medical therapy alone. At 5 years, the amiodarone arm had a survival rate equivalent to that of the placebo arm and higher costs than the placebo arm. For ICD relative to medical therapy alone, the base case lifetime cost-effectiveness and cost-utility ratios (discounted at 3%) were $38 389 per life-year saved (LYS) and $41 530 per quality-adjusted LYS, respectively. A cost-effectiveness ratio Conclusions— Prophylactic use of single-lead, shock-only ICD therapy is economically attractive in patients with stable, moderately symptomatic heart failure with an ejection fraction ≤35%, particularly those in NYHA class II, as long as the benefits of ICD therapy observed in the SCD-HeFT persist for at least 8 years. |
| Databáze: | OpenAIRE |
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