Abstract 19452: Cost-Effectiveness of Single-Chamber Compared with Dual-Chamber and Single-Lead with Atrial Sensing Implantable Cardioverter Defibrillators
Introduction: In patients receiving primary or secondary prevention implantable cardioverter defibrillators (ICDs) without pacing indications, dual-chamber devices may increase perioperative risks compared with single-chamber devices, yet they may also detect atrial fibrillation (AF) and prevent inappropriate shocks.
Hypothesis: Dual-chamber and single-lead with atrial sensing ICDs may be a cost-effective alternative to single-chamber ICDs.
Methods: We used a Markov decision model to evaluate the costs, quality adjusted life expectancy and incremental cost-effectiveness of single-chamber, dual-chamber, and single-lead with atrial sensing ICDs. Our base case was a 65 year-old patient receiving a primary or secondary prevention ICD without pacing indications. The model included perioperative adverse events and long-term inappropriate shocks, AF detection, AF treatment, and stroke.
Results: When compared to the single-chamber ICD, the dual-chamber ICD had an incremental-cost-effectiveness ratio (ICER) of $44,087 per quality-adjusted life-year (QALY) gained (Table). When the new single-lead ICD with atrial sensing was added as an alternative therapy, it had an ICER of $23,904 per QALY compared to the single-chamber device. These results were sensitive to the patient’s age, and the ability of the atrial sensing devices to detect atrial fibrillation and avoid inappropriate shocks.
Conclusions: For patients receiving primary or secondary prevention ICDs without pacing indications, dual-chamber ICDs may be cost-effective relative to single-chamber devices and a new single-lead with atrial sensing ICD is likely a very cost-effective alternative.
Author Disclosures: D.W. Hutton: Research Grant; Modest; Biotronik. M.J. Harvey: Research Grant; Modest; Biotronik. J.P. Thaker: Research Grant; Modest; Biotronik. J.V. Freeman: Consultant/Advisory Board; Modest; Janssen Scientific Affairs, LLC..
- © 2014 by American Heart Association, Inc.