Jan 1, 2007, 00:00 AM

10.1111/j.1524-4733.2006.00138.x

https://www.valueinhealthjournal.com/article/S1098-3015(10)60448-2/fulltext

Section Title :

Section Order : 9

First Page :

Sudden cardiac death (SCD) is one of the most common causes of death in Western countries, and the implantable cardioverter defibrillator (ICD) is the treatment which has the most striking preventive impact in high-risk patients with heart disease. Randomized clinical trials have produced strong evidence that prophylactic use of ICDs in appropriately selected patients is associated with improved survival at 2 to 5 years of follow-up; these findings regard patients with previous ventricular tachyarrhythmias (secondary prevention of SCD), and also patients with a high-risk profile but no previous ventricular tachyarrhythmias (so-called primary prevention) [1,2]. During the last few years, increasingly broad indications for ICD therapy have been incorporated into consensus guidelines on the management of both arrhythmia and heart failure [3]. At the same time, major concerns have been voiced about the financial implications of wide adoption of ICDs [1], in view of the high number of potential candidates, particularly among elderly heart failure patients. The ICD has traditionally been perceived as a financially burdensome form of treatment. This is due to the high up-front cost of the device (currently at least $15,000 in the United States), coupled with delayed evidence of benefit (if any) in individual patients. As a consequence, great interest has been focused on economic studies of the use of ICDs in SCD prevention. In particular, a series of cost-effectiveness and cost-utility analyses based on trials or decision models have been performed and compared [4,5].

In this issue of Value in Health, Caro et al. [6] present probably the first available cost-benefit analysis on ICDs in primary prevention. The investigators performed a comparison of cost-benefit values estimated for ICD versus prophylactic treatment with the most prominent antiarrhythmic drug, amiodarone. This modeling study was based on discrete event simulation of data derived from a major, ground-breaking clinical trial (Sudden Cardiac Death in Heart Failure Trial, which compared the efficacy of ICDs and amiodarone for the primary prevention of SCD in heart failure patients), together with data from an important meta-analysis of more than 6500 patients enrolled in randomized clinical trials on amiodarone. The authors’ conclusion that in “countries where society values a life at more than more than €2 million, ICDs are a worthwhile investment compared with amiodarone for primary prevention” raises important issues on the implications of cost-benefit estimates in this particular clinical and epidemiological  setting.

https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(10)60448-2&doi=10.1111/j.1524-4733.2006.00138.x

HEOR Topics :

• Cardiovascular Disorders
• Cost-comparison, Effectiveness, Utility, Benefit Analysis
• Economic Evaluation
• Specific Diseases & Conditions

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• Global