(Circulation. 2001;103:1416.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Cost-Effectiveness of the Implantable Cardioverter-Defibrillator
Results From the Canadian Implantable Defibrillator Study (CIDS)
From the Department of Clinical Epidemiology and Biostatistics (B.J.O., R.G., G.B., A.W., R.S.R., M.G.) and the Department of Medicine (S.J.C.), McMaster University, Hamilton, Ontario, Canada; Centre for Evaluation of Medicines (B.J.O., R.G., G.B., A.W.), St. Joseph’s Hospital, Hamilton, Ontario, Canada; Department of Medicine (R.Y.), University of Western Ontario, Hamilton, Ontario, Canada; and Hamilton Civic Hospitals Research Centre (R.S.R., M.G.), Hamilton, Ontario, Canada.
Background—In the Canadian Implantable Defibrillator Study (CIDS), we assessed the cost-effectiveness of the implantable cardioverter-defibrillator (ICD) in reducing the risk of death in survivors of previous ventricular tachycardia (VT) or fibrillation (VF).
Methods and
Results—Healthcare resource use was collected
prospectively on the first 430 patients enrolled in CIDS (n=212 ICD,
n=218 amiodarone). Mean cost per patient, adjusted for censoring, was
computed for each group based on initial therapy assignment.
Incremental cost-effectiveness of ICD therapy was computed as the ratio
of the difference in cost (ICD minus amiodarone) to the difference in
life expectancy (both discounted at 3% per year). All costs are in
1999 Canadian dollars (C$1 
US$0.65). Over 6.3 years, mean cost per
patient in the ICD group was C$87 715 versus C$38 600 in the
amiodarone group (difference C$49 115; 95% CI C$25 502 to
C$69 508). Life expectancy for the ICD group was 4.58 years versus
4.35 years for amiodarone (difference 0.23, 95% CI -0.09 to 0.55),
for incremental cost-effectiveness of ICD therapy of C$213 543 per
life-year gained. ICD benefit was greater in patients with low left
ventricular ejection fraction (<35%), and cost-effectiveness in this
group was more attractive (C$108 484). Alternative extrapolations of
survival benefit and costs to 12 years indicated cost-effectiveness in
the range of C$100 000 to C$150 000 per life-year
gained.
Conclusions—At C$213 543, the value for the money offered by ICD therapy is not attractive by currently accepted standards. Further research is warranted to identify the indications and patient subgroups for whom ICDs are a cost-effective use of resources.
Key Words: heart-assist device • defibrillation • cardioversion • tachyarrhythmias • cost-benefit analysis
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