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Health Care Costs and Financing

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Implantable pacemakers are cost-effective in preventing sudden death in people without a life-threatening cardiac arrhythmia

The implantable cardioverter-defibrillator (ICD) can convert episodes of irregular and abnormally fast heart rhythm to regular cardiac sinus rhythm, thus potentially averting sudden death from cardiac causes. ICDs have been shown to reduce the risk of death among patients resuscitated from a cardiac arrest. However, prophylactic use of ICDs may also be cost-effective for patients at risk for sudden death due to poor functioning of the heart's left ventricle, but who have not had a life-threatening cardiac arrhythmia, suggests a study supported in part by the Agency for Healthcare Research and Quality (HS10623).

Researchers reviewed the results of eight clinical trials that randomly assigned patients to receive an ICD or alternative therapy, and developed a model to assess the cost-effectiveness of the ICD in these patients. Two studies found that prophylactic implantation of an ICD in these patients did not reduce the risk of death, and thus was more expensive and less effective than alternative therapy. However, for the other six trials, the use of an ICD was projected to add between 1 and 3 quality-adjusted life-years (QALY) and between $68,300 and $101,500 in cost.

The researchers calculated that the cost-effectiveness of the ICD as compared with control therapy in these six populations ranged from $34,000 to $70,200 per QALY gained. This cost-effectiveness ratio would remain below $100,000 per QALY as long as the ICD reduced mortality for 7 or more years. The prophylactic ICD resulted in a substantial increase in life expectancy compared with that provided by many other medical interventions. Also, its cost-effectiveness in appropriately selected patients was similar to that of other medical interventions often accepted as cost-effective.

More details are in "Cost-effectiveness of implantable cardioverter-defibrillators," by Gillian D. Sanders, Ph.D., Mark A. Hlatky, M.D., and Douglas K. Owens, M.D., in the October 6, 2005, New England Journal of Medicine 353, pp. 1471-1480.

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