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From the Departments of Community and Preventive Medicine (A.I.M., J.Z.,
E.G., M.A., R.M., A.J.M.), Medicine (A.I.M., A.J.M.), and Biostatistics
(W.J.H., K.H.Z.), University of Rochester School of Medicine and Dentistry,
Rochester, New York.
Correspondence to Alvin I. Mushlin, MD, ScM, University of Rochester Medical Center, Department of Community and Preventive Medicine, Box 644, 601 Elmwood Ave, Rochester, NY 14642. E-mail mushlin{at}prevmed.rochester.edu
Background—The recently reported
Multicenter Automatic Defibrillator Implantation Trial (MADIT) showed
improved survival in selected asymptomatic patients with
coronary disease and nonsustained ventricular
tachycardia. The economic consequences of defibrillator
management in this patient population are unknown.
Methods and Results—Patients were followed up to quantify their
use of healthcare services, including hospitalizations, physician
visits, medications, laboratory tests, and procedures, during the
trial. The costs of these services, including the costs of the
defibrillator, were determined in patients randomized to defibrillator
and nondefibrillator therapy. Incremental cost-effectiveness ratios
were calculated by relating these costs to the increased survival
associated with the use of the defibrillator. The average survival for
the defibrillator group over a 4-year period was 3.66 years compared
with 2.80 years for conventionally treated patients. Accumulated net
costs were $97 560 for the defibrillator group compared with $75 980
for individuals treated with medications alone. The resulting
incremental cost-effectiveness ratio of $27 000 per life-year saved
compares favorably with other cardiac interventions. Sensitivity
analyses showed that the incremental cost-effectiveness ratio
would be reduced to
Conclusions—An implanted cardiac defibrillator is cost-effective
in selected individuals at high risk for ventricular
arrhythmias.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
The Cost-effectiveness of Automatic Implantable Cardiac Defibrillators:
Results From MADIT
$23 000 per life-year saved if transvenous
defibrillators were used instead of the older devices, which required
thoracic surgery for implantation.
Key Words: cost-effectiveness • cardioversion • defibrillation
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