| Cost-effectiveness of implantable defibrillator as first-choice therapy versus electrophysiologically guided, tiered strategy in postinfarct sudden death survivors. A randomized study. | |
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MedLine Citation:
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PMID: 8565166 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Rising costs of health care, partly as a result of costly therapeutic innovations, are of concern to both the medical profession and healthcare authorities. The implantable cardioverter-defibrillator (ICD) is still not remunerated by Dutch healthcare insurers. The aim of this study was to evaluate the cost-effectiveness of early implantation of the ICD in postinfarct sudden death survivors. METHODS AND RESULTS: Sixty consecutive postinfarct survivors of cardiac arrest caused by ventricular tachycardia or fibrillation were randomly assigned either ICD as first choice (n = 29) or a tiered therapy starting with antiarrhythmic drugs and guided by electrophysiological (EP) testing (n = 31). Median follow-up was 729 days (range, 3 to 1675 days). Fifteen patients died, 4 in the early ICD group and 11 in the EP-guided strategy group (P = .07). For quantitative assessment, the cost-effectiveness ratio was calculated for both groups and expressed as median total costs per patient per day alive. Because effectiveness aspects other than mortality are not incorporated in this ratio, other factors related to quality of life were used as qualitative measures of cost-effectiveness. The cost-effectiveness ratios were $63 and $94 for the early ICD and EP-guided strategy groups, respectively, per patient per day alive. This amounts to a net cost-effectiveness of $11,315 per patient per year alive saved by early ICD implantation. Costs in the early ICD group were higher only during the first 3 months of follow-up, but as a result of the high proportion of therapy changes, including arrhythmia surgery and late ICD implantation, costs in the EP-guided strategy group became higher after that. Patients discharged with antiarrhythmic drugs as sole therapy had the lowest total costs. This subset, however, showed extremely high mortality, resulting in a poor cost-effectiveness ratio ($196 per day). Invasive therapies and hospitalization were the major contributors to costs. If quality-of-life measures are taken into account, the cost-effectiveness of early ICD implantation was even more favorable. Recurrent cardiac arrest and cardiac transplantation occurred in the EP-guided strategy group only, whereas exercise tolerance, total hospitalization duration, number of invasive procedures, and antiarrhythmic therapy changes were significantly in favor of early ICD implantation. CONCLUSIONS: In terms of cost-effectiveness, early ICD implantation is superior to the EP-guided therapeutic strategy in postinfarct sudden death survivors. |
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Authors:
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E F Wever; R N Hauer; G Schrijvers; F J van Capelle; J G Tijssen; H J Crijns; A Algra; H Ramanna; P F Bakker; E O Robles de Medina |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Circulation Volume: 93 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1996 Feb |
Date Detail:
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Created Date: 1996-03-04 Completed Date: 1996-03-04 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 489-96 Citation Subset: AIM; IM |
Affiliation:
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Heart-Lung Institute, University Hospital, University of Utrecht, Netherlands. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anti-Arrhythmia Agents
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therapeutic use Cost-Benefit Analysis Death, Sudden, Cardiac Defibrillators, Implantable / economics* Electrocardiography Follow-Up Studies Heart Arrest / economics, therapy* Humans Myocardial Infarction / complications* Quality of Life Tachycardia, Ventricular / therapy Ventricular Fibrillation / therapy |
| Chemical | |
Reg. No./Substance:
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0/Anti-Arrhythmia Agents |
| Comments/Corrections | |
Comment In:
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Circulation. 1996 Nov 1;94(9):2321-2
[PMID:
8901705
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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