Journal article
Implantable or External Defibrillators for Individuals at Increased Risk of Cardiac Arrest: Where Cost-Effectiveness Hits Fiscal Reality
Value in health, Vol.9(5), pp.292-302
2006
DOI: 10.1111/j.1524-4733.2006.00118.x
PMID: 16961547
Abstract
Implantable cardioverter defibrillators (ICDs) are highly effective at preventing cardiac arrest, but their availability is limited by high cost. Automated external defibrillators (AEDs) are likely to be less effective, but also less expensive. We used decision analysis to evaluate the clinical and economic trade-offs of AEDs, ICDs, and emergency medical services equipped with defibrillators (EMS-D) for reducing cardiac arrest mortality.
A Markov model was developed to compare the cost-effectiveness of three strategies in adults meeting entry criteria for the MADIT II Trial: strategy 1, individuals experiencing cardiac arrest are treated by EMS-D; strategy 2, individuals experiencing cardiac arrest are treated with an in-home AED; and strategy 3, individuals receive a prophylactic ICD. The model was then used to quantify the aggregate societal benefit of these three strategies under the conditions of a constrained federal budget.
Compared with EMS-D, in-home AEDs produced a gain of 0.05 quality-adjusted life-years (QALYs) at an incremental cost of $5225 ($104,500 per QALY), while ICDs produced a gain of 0.90 QALYs at a cost of $114,660 ($127,400 per QALY). For every $1 million spent on defibrillators, 1.7 additional QALYs are produced by purchasing AEDs (9.6 QALYs/$million) instead of ICDs (7.9 QALYs/$million). Results were most sensitive to defibrillator complication rates and effectiveness, defibrillator cost, and adults' risk of cardiac arrest.
Both AEDs and ICDs reduce cardiac arrest mortality, but AEDs are significantly less expensive and less effective. If financial constraints were to lead to rationing of defibrillators, it might be preferable to provide more people with a less effective and less expensive intervention (in-home AEDs) instead of providing fewer people with a more effective and more costly intervention (ICDs).
Details
- Title: Subtitle
- Implantable or External Defibrillators for Individuals at Increased Risk of Cardiac Arrest: Where Cost-Effectiveness Hits Fiscal Reality
- Creators
- Peter Cram - University of Iowa College of Medicine, Iowa City, IA, USADavid Katz - University of Iowa College of Medicine, Iowa City, IA, USASandeep Vijan - Ann Arbor Veterans Affairs Health Services Research and Development Field Program, Ann Arbor, MI, USADavid M Kent - Institute for Clinical Research and Health Policy Studies, Tufts–New England Medical Center, Boston, MA, USAKenneth M Langa - Ann Arbor Veterans Affairs Health Services Research and Development Field Program, Ann Arbor, MI, USAA. Mark Fendrick - University of Michigan School of Medicine, Ann Arbor, MI, USA
- Resource Type
- Journal article
- Publication Details
- Value in health, Vol.9(5), pp.292-302
- Publisher
- Elsevier Inc
- DOI
- 10.1111/j.1524-4733.2006.00118.x
- PMID
- 16961547
- ISSN
- 1098-3015
- eISSN
- 1524-4733
- Language
- English
- Date published
- 2006
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094611502771
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