WEDNESDAY, Oct. 5 (HealthDay News) -- The prophylactic implantation of an implantable cardioverter-defibrillator (ICD) has a cost-effectiveness ratio below $100,000 per quality-adjusted life year (QALY) in patients at risk of sudden death who have not had a life-threatening arrhythmia, according to a study in the Oct. 6 issue of the New England Journal of Medicine.
Gillian D. Sanders, Ph.D., of the Duke Clinical Research Institute, Duke University, Durham, N.C., and colleagues analyzed data from eight clinical trials on the prophylactic use of ICDs and developed a model to measure the cost-effectiveness compared with control therapy.
Lifetime costs were increased in every trial, and in all but two trials ICD implantation added 1.01 to 2.99 QALYs at a cost of $68,300 to $101,500. Assuming that the use of an ICD reduced mortality for at least seven years, the cost per QALY would remain below $100,000, the authors conclude, but they note that prophylactic implantation of an ICD is problematic for health policymakers.
"Even if this approach is used only in patient populations in which it has been shown to be cost-effective, the aggregate expenditure in the United States for ICDs could easily exceed several billion dollars per year. If clinicians extend the prophylactic use of ICDs to lower-risk patients in whom the efficacy is lower and cost-effectiveness less favorable, the societal cost will rise further," the authors conclude.
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