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Heart Disease and Stroke

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Implantable defibrillators reduce cardiac deaths and are as cost effective as many generally accepted therapies

An estimated 1,000 people suffer from cardiac arrest each day in the United States, and 220,000 Americans die from it each year. Fortunately, implantable cardioverter defibrillators, which can sense abnormal heart rhythms and deliver a shock to restore a normal heartbeat, improve the survival of patients at risk for cardiac arrest. These devices are also as cost effective as some, but not all, generally accepted therapies, according to a study supported by the Agency for Healthcare Research and Quality (HS08362).

Mark A. Hlatky, M.D., of Stanford University School of Medicine, and his colleagues identified 7,612 matched pairs of elderly Medicare patients from a nationwide sample of patients discharged between 1987 and 1995. These patients had been hospitalized for ventricular tachycardia (abnormally fast heartbeat) or ventricular fibrillation (irregular heartbeat).

The investigators compared mortality and care costs for the patients in the matched pairs who received a defibrillator with the patients who were treated medically (but had similar severity of illness and prognosis) during 8 years of followup. Overall, defibrillator patients had 34 percent fewer deaths. Significantly fewer of those who received a defibrillator had died at 1 year (11 vs. 19 percent), 2 years (20 vs. 30 percent) and 3 years (28 vs. 39 percent). By 8 years, fewer patients who received defibrillators had died compared with those who did not receive defibrillators, but the advantage of the defibrillator decreased over time. Median survival for the defibrillator group also was longer (5.7 vs. 4.6 years).

Health care expenditures among patients who received a defibrillator were consistently higher than among medically treated patients ($48,700 vs. $17,000 during the first year). This is not surprising, since the device costs more than $20,000, and there are additional costs for implantation. Over the 8-year period, the difference grew to $78,700 for defibrillator patients versus $37,200 for medically treated patients, with a cost-effectiveness ratio of $78,400 per life-year gained. Although above a common benchmark of $50,000 per life-year saved, it is comparable to several other commonly accepted medical interventions.

See "Effectiveness and cost-effectiveness of implantable cardioverter defibrillators in the treatment of ventricular arrhythmias among Medicare beneficiaries," by J. Peter Weiss, M.D., Olga Saynina, M.A., M.B.A., Kathryn M. McDonald, M.M., and others, in the May 2002 American Journal of Medicine 112, pp. 519-527.

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