We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II.
- Authors
Al-Khatib, Sana M.; Anstrom, Kevin J.; Eisenstein, Eric L.; Peterson, Eric D.; Jollis, James G.; Mark, Daniel B.; Yun Li; O'connor, Christopher M.; Shaw, Linda K.; Califf, Robert M.; Li, Yun
- Abstract
<bold>Background: </bold>The Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II demonstrated that implantable cardioverter defibrillators (ICDs) save lives when used in patients with a history of myocardial infarction (MI) and an ejection fraction of 0.3 or less.<bold>Objective: </bold>To investigate the cost-effectiveness of implanting ICDs in patients who met MADIT-II eligibility criteria and were enrolled in the Duke Cardiovascular Database between 1 January 1986 and 31 December 2001.<bold>Design: </bold>Cost-effectiveness analysis.<bold>Data Sources: </bold>Published literature, databases owned by Duke University Medical Center, and Medicare data.<bold>Target Population: </bold>Adults with a history of MI and an ejection fraction of 0.3 or less.<bold>Time Horizon: </bold>Lifetime.<bold>Perspective: </bold>Societal.<bold>Interventions: </bold>ICD therapy versus conventional medical therapy.<bold>Outcomes Measures: </bold>Cost per life-year gained and incremental cost-effectiveness.<bold>Results: </bold>Compared with conventional medical therapy, ICDs are projected to result in an increase of 1.80 discounted years in life expectancy and an incremental cost-effectiveness ratio of 50,500 dollars per life-year gained. Cost-effectiveness varied dramatically with changes in time horizon: The cost-effectiveness ratio increased to 67,800 dollars per life-year gained, 79,900 dollars per life-year gained, 100,000 dollars per life-year gained, 167,900 dollars per life-year gained, and 367,200 dollars per life-year gained for 15-year, 12-year, 9-year, 6-year, and 3-year time horizons, respectively. Changing the frequency of follow-up visits, complication rates, and battery replacements had less of an effect on the cost-effectiveness ratios than reducing the cost of ICD placement and leads.<bold>Limitations: </bold>The study was limited by the completeness of the data, referral bias, difference in medical therapy between the Duke cohort and the MADIT-II cohort, and not addressing potential upgrades to biventricular devices.<bold>Conclusions: </bold>The economic expense of defibrillator implantation in all patients who meet MADIT-II eligibility criteria is substantial. However, in the range of survival benefit observed in MADIT-II, ICD therapy for these patients is economically attractive by conventional standards.
- Subjects
MYOCARDIAL infarction; DEFIBRILLATORS; MEDICAL equipment; THERAPEUTICS; CLINICAL trials; MEDICARE
- Publication
Annals of Internal Medicine, 2005, Vol 142, Issue 8, p593
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-142-8-200504190-00007