Abstract 3233: Cost-Effectiveness of the Implantable Cardioverter Defibrillator in the Elderly
Background: Over 80% of sudden cardiac deaths (SCDs) occur in patients >= 65 years old, yet the major ICD randomized trials enrolled very few elderly patients. Thus, the cost-effectiveness of ICD therapy in patients >= 65-years old remains unclear.
Methods: Using a Markov model, we evaluated the lifetime costs, benefits, and cost-effectiveness of ICD therapy for primary prevention in those aged >= 65 years. Treatment efficacies were based on 8 primary prevention trials while ranges for sensitivity analyses for complications, quality of life, and costs were derived from a systematic literature review and varied across clinically valid ranges.
Results: The mean age of patients in the 8 trials varied from 58.4 years in DEFINITE to 66 years in MUSTT. In patients >= 65 years, ICD’s were associated with between a 62% reduction in total mortality in MADIT-I to a 23% increase in mortality observed in DINAMIT. The incremental cost-effectiveness of ICD therapy for an average 70-year old patient in the six trials demonstrating overall ICD effectiveness, ranged from $32,400 per quality-adjusted life year (QALY) in MADIT-I, to $115,600/QALY in SCD-HeFT. These cost-effectiveness ratios rose to between $35,100-$131,000/QALY for an 80-year old patient.
Conclusion: The cost-effectiveness of ICD therapy for primary prevention in the elderly varies widely among existing trials. Given the high cost of ICD devices, and the increasing US elderly population, further studies of the ICD in this under-represented population are strongly needed.